609. Decreasing Time to Effective Management of Candidemia Using An Antimicrobial Stewardship Program (ASP) Approach
Session: Abstracts: Mycology
Friday, October 22, 2010
Background: Delay to effective candidemia treatment increases morbidity, mortality and hospital cost.  The objective is to evaluate time to effective treatment before and after implementation of a candidemia management algorithm incorporating ASP.

Methods: The presence of yeast on Gram stain from blood is a critical laboratory value requiring 24/7 physician notification by the microbiology laboratory.  The algorithm was implemented in January 2010 incorporating the addition of ASP pharmacist notification Mon – Fri 7am – 5pm.  Episodes between Jan – April 2008 and Jan – April 2010 were retrospectively compared to evaluate the impact of real-time ASP pharmacist notification.  Time to effective antifungal therapy, in-hospital duration of therapy, post-positive culture length of stay (LOS), and overall mortality were assessed.

Results: Fifty episodes were analyzed (26 pre- and 24 post-algorithm).  Seventy-five percent of the post-algorithm episodes occurred after normal business hours with a median of 11.1 hours to effective therapy after provider notification by the microbiology laboratory.  The remaining 25% occurred Mon – Fri 7am – 5pm allowing ASP pharmacist intervention.  Median time to effective antifungal therapy after provider notification by the microbiology laboratory was 9.9 hours in the pre-algorithm & 1.4 hours in the intervention group (p =0.03).  In-hospital duration of therapy was 8.5 days & 10.5 days (p = 0.86), post-positive culture LOS was 11 & 12 days (p = 0.81), and overall mortality was 15% & 0% (p = 0.55), in the pre-algorithm and intervention groups, respectively.

Conclusion: Guidelines for the management of candidemia are well known, yet assessment of guideline compliance is limited.  Implementation of an ASP approach to optimize candidemia management decreased time to effective antifungal therapy.  Continued education is necessary.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Speakers:
Erica E. Reed, PharmD , Ohio State University Medical Center, Columbus, OH
Ellen Keating, PharmD, MS , Ohio State University Medical Center, Columbus, OH
Karri A. Bauer, PharmD , The Ohio State University Medical Center, Columbus, OH
Jessica West, MSPH , Infectious Diseases, The Ohio State University Medical Center, Columbus, OH
Preeti Pancholi, PhD , Clinical Microbiology, The Ohio State Univ Med Ctr, Columbus, OH
Joan-Miquel Balada-Llasat, PharmD, PhD , Clinical Microbiology, The Ohio State University Medical Center, Columbus, OH
Julie E. Mangino, MD , The Ohio State University Medical Center, Columbus, OH
Debra A. Goff, PharmD , Ohio State University Medical Center, Columbus, OH

Disclosures:

E. E. Reed, None

E. Keating, None

K. A. Bauer, None

J. West, None

P. Pancholi, None

J. M. Balada-Llasat, None

J. E. Mangino, None

D. A. Goff, None

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