title: Management bundles for candidaemia: the impact of compliance on clinical outcomes.
abstract: OBJECTIVE
  The Mycoses Forum in Japan has developed management bundles for candidaemia to incorporate into bedside practice. The aim of this study was to investigate nationwide compliance with the bundles and their impact on clinical outcomes.
  
  
  METHODS
  Non-neutropenic patients treated with antifungals for candidaemia were surveyed. Bundles consist of nine items to complete. Data were sent to the central office between July 2011 and April 2012.
  
  
  RESULTS
  Six hundred and eight patients were analysed. The compliance rate for achieving all elements was 6.9%, and it increased to 21.4% when compliance was analysed by the bundle except for oral switch. There was a significant difference in clinical success between patients with and without compliance [92.9% versus 75.8% (P=0.011)]. Compliance with the bundles, however, failed to be an independent factor associated with favourable outcomes. When step-down oral therapy was excluded from the elements of compliance, compliance with the bundles was revealed to be an independent predictor of clinical success (OR 4.42, 95% CI 2.05-9.52) and mortality (OR 0.27, 95% CI 0.13-0.57). Independent individual elements contributing to clinical success were removal of central venous catheters within 24 h, assessment of clinical efficacy on the third to the fifth day and at least 2 weeks of therapy after clearance of candidaemia.
  
  
  CONCLUSIONS
  Compliance with the bundles for candidaemia had a beneficial effect on clinical outcomes. Promotion of the bundles approach may have the potential to narrow the gap between clinical evidence and bedside practice.
authors.affiliation: ACTIONs Project Committee of Mycoses Forum, Nittochi Toranomon Building, 1-10-5 Toranomon, Minato-ku, Tokyo, 105-8320, Japan Department of Infection Prevention and Control, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan takesuey@hyo-med.ac.jp.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Takesue
authors.affiliation: Department of Infection Prevention and Control, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ueda
authors.affiliation: ACTIONs Project Committee of Mycoses Forum, Nittochi Toranomon Building, 1-10-5 Toranomon, Minato-ku, Tokyo, 105-8320, Japan.
authors.forename: Hiroshige
authors.initials: H
authors.lastname: Mikamo
authors.affiliation: ACTIONs Project Committee of Mycoses Forum, Nittochi Toranomon Building, 1-10-5 Toranomon, Minato-ku, Tokyo, 105-8320, Japan.
authors.forename: Shigeto
authors.initials: S
authors.lastname: Oda
authors.affiliation: ACTIONs Project Committee of Mycoses Forum, Nittochi Toranomon Building, 1-10-5 Toranomon, Minato-ku, Tokyo, 105-8320, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Takakura
authors.affiliation: ACTIONs Project Committee of Mycoses Forum, Nittochi Toranomon Building, 1-10-5 Toranomon, Minato-ku, Tokyo, 105-8320, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
authors.affiliation: ACTIONs Project Committee of Mycoses Forum, Nittochi Toranomon Building, 1-10-5 Toranomon, Minato-ku, Tokyo, 105-8320, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kohno
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D058387:Candidemia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy; D019468:Disease Management; D019983:Guideline Adherence; D006801:Humans; D007564:Japan / Q000453:epidemiology; D009026:Mortality; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D012042:Registries
chemical_list: D000935:Antifungal Agents
keywords: candidiasis; fungal infections; guidelines; intravenous catheters; invasive disease