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Impact of Infectious Diseases Consultation on Mortality and Treatment of Patients with Candida Bloodstream Infections: A Retrospective Cohort Study
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12 2019
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Source: Lancet Infect Dis. 19(12):1336-1344
[PDF-527.83 KB]
Details:
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Alternative Title:Lancet Infect Dis
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Personal Author:
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Description:Background
Candida blood stream infection (BSI) is associated with high mortality. Infectious diseases (ID) consultation improves outcomes in several infections, including Staphylococcus aureus, cryptococcosis and resistant organisms. We examine the association between ID consultation for Candida BSI with mortality and differences in management.
Methods
In this retrospective, single-center cohort study, medical charts of all hospitalized patients ≥18 years old with Candida BSI from 2002 to 2015 were reviewed. We collected demographics, comorbidities, predisposing factors, all-cause mortality, antifungal usage, central line removal, ophthalmologic and echocardiographic evaluation to evaluate 90-day all-cause mortality between those with and without an ID consult. For the survival analysis we used Cox proportional hazards model with inverse weighting by propensity score to have an ID consult.
Findings
Analysis included 1,691 patients; 776 (45.9%) in the ID consult group. Most underlying comorbidities were evenly distributed between groups. Ninety-day mortality was 40.8% (690 patients). In the model with inverse weighting by the propensity score, ID consult was associated with a hazard ratio of 0.81 (95% CI: 0.73, 0.91, p<0.001) for mortality. In the consult group median duration of antifungal therapy was longer (18 vs 14 days, p<0.001) and central line removal (75.6% [587/776] vs 58.8% [538/915], p<0.001), echocardiography use (56.9% [442/776] vs 33.3% [305/915], p<0.001) and ophthalmologic examination (53.1% [412/776] vs 17.5% [160/915], p<0.001) were more frequently done. Fewer patients in the ID consult group were not treated (1.7% [13/776] vs 14% [128/915], p<0.001).
Interpretation
Patients with Candida BSI receiving an ID consult have lower mortality. This may be attributable to a higher receipt of non-pharmacological, evidence-based interventions and lower rate of non-treatment. These data suggest that an ID consult should be an integral part of clinical care of patients with Candida BSI.
Funding
Astellas Global Development Pharma, Inc., Washington University Institute of Clinical and Translational Sciences, the Agency for Healthcare Research and Quality.
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Pubmed ID:31562024
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Pubmed Central ID:PMC7014922
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