title: Evaluation of a positive yeast-in-blood service.
abstract: BACKGROUND
  The purpose of this study was to evaluate the effect of a novel "yeast-in-blood" surveillance service on the timeliness of antifungal chemotherapy for candidemia.
  
  
  METHODS
  Two hundred seven blood cultures positive for Candida species between July 1, 1994, and February 15, 2009, as identified by the microbiology positive culture log, were included in this retrospective chart review. Patients with a positive culture before July 1, 2008, were evaluated by the yeast-in-blood surveillance service and included as intervention cases (IC). After this time, those occurring after discontinuation of the service were included as nonintervention cases (NIC). The primary outcome measure was the time to antifungal therapy from the time of blood culture draw. Secondary outcome measures included antifungal selection and time to antifungal prescription order from culture positivity.
  
  
  RESULTS
  Median time to therapy was 58.9±28.4 hours and 41.3±30.5 hours for NIC and IC, respectively (P=0.001). Median time to prescription order was 3.0±6.9 hours for NIC versus 1.9±3.9 hours for IC. Candida albicans was the predominant organism identified (45.3% of NIC and 54.6% of IC). Treatment agents included an azole in 57.4% of NIC and 47.4% of IC, an echinocandin in 33.3% and 27.3% and a polyene in 5.7% and 27.8%, respectively.
  
  
  CONCLUSIONS
  Time to therapy and time to prescription were shorter in those evaluated by the surveillance service. These data suggest that a yeast surveillance service improves antifungal medication therapy initiation.
authors: Department of Pharmacy Practice (KRS, JDC), University of Mississippi Medical Center, Jackson, Mississippi; and Division of Infectious Diseases, Department of Medicine (KRS, RLN, JDC), University of Mississippi Medical Center, Jackson, Mississippi.
authors: Kayla R
authors: KR
authors: Stover
authors: Rathel L
authors: RL
authors: Nolan
authors: John D
authors: JD
authors: Cleary
mesh_terms: D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000097:blood*; D002175:Candida / Q000302:isolation & purification* / Q000378:metabolism; D015169:Colony Count, Microbial / Q000379:methods / Q000592:standards; D005260:Female; D006403:Hematologic Tests / Q000379:methods / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018571:Sentinel Surveillance; D013997:Time Factors; D015003:Yeasts / Q000302:isolation & purification / Q000378:metabolism; D055815:Young Adult
chemical_list: D000935:Antifungal Agents