title: Improving the management of candidemia through antimicrobial stewardship interventions.
abstract: Candidemia is associated with significant morbidity, mortality, and hospital cost. We conducted a quasi-experimental study to evaluate the impact of an Antimicrobial Stewardship Program (ASP) pharmacist's interventions on time to effective antifungal therapy, in-hospital mortality, infection-related length of stay (LOS), and costs in patients with candidemia. Patients in 2008 (pre-intervention, n = 85) were compared to those in 2010 (post-intervention, n = 88). Time to effective therapy was significantly faster (median 13.5 versus 1.3 hours, P = 0.04) and was administered to more patients in the post-intervention group [67 (88%) versus 80 (99%), P = 0.008]. There was no significant difference in in-hospital mortality [16 (19%) versus 26 (30%) patients, P = 0.11], infection-related LOS [10 (7-15.5) versus 11 (7-17) days, P = 0.68], or hospital costs during candidemia [$25,697 (15,645-42,870) versus $31,457 ($16,399-83,649), P = 0.25]. ASP pharmacist interventions standardized and improved the quality of care of patients with candidemia.
authors: Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors: Erica E
authors: EE
authors: Reed
authors: Division of Infectious Diseases, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors: Jessica E
authors: JE
authors: West
authors: Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors: Ellen A
authors: EA
authors: Keating
authors: Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors: Preeti
authors: P
authors: Pancholi
authors: Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors: Joan-Miquel
authors: JM
authors: Balada-Llasat
authors: Division of Infectious Diseases, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors: Julie E
authors: JE
authors: Mangino
authors: Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors: Karri A
authors: KA
authors: Bauer
authors: Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Electronic address: Debbie.Goff@osumc.edu.
authors: Debra A
authors: DA
authors: Goff
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000145:classification / Q000302:isolation & purification; D058387:Candidemia / Q000453:epidemiology* / Q000517:prevention & control*; D003428:Cross Infection; D011307:Drug Prescriptions; D061345:Early Medical Intervention / Q000379:methods; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010595:Pharmacists; D010820:Physicians
chemical_list: D000935:Antifungal Agents
keywords: Antimicrobial stewardship; Candidemia; Cost; Outcomes