610. Evaluation of a Positive Yeast-in-Blood Service
Session: Abstracts: Mycology
Friday, October 22, 2010
Background: Candida species is a leading cause of nosocomial blood stream infections.  Any delay in therapy may lead to increased length of stay, cost, and mortality. The purpose of this study was to evaluate if a novel ”yeast-in-blood” surveillance service impacts the timeliness and appropriateness of antifungal therapy in the treatment of candidemia. 

Methods: A retrospective case-historical control study of patients with a blood culture positive for yeast after July 1, 1994 as identified by the microbiology laboratory. This study compared controls evaluated by the surveillance service to cases that occurred after the service was discontinued. An assessment of the success of the surveillance service was made by comparison of these groups. The primary outcome measure was the time to appropriate antifungal treatment from the time of culture (TTx). Secondary outcome measures included time to prescription order from culture positivity (TRx) and selection of appropriate antifungal therapy as defined by the IDSA guidelines.    

Results: TTx was 54.8 ± 28.4 hr and 53.2 ± 30.5 hr for cases and controls, respectively. 32% vs. 27% of cases vs. controls were treated empirically, 2% vs. 3% were < 4 hr, and 64% vs. 66% were > 4 hr. Average TRx was 5.5 ± 6.9 hr for cases versus 4.1 ± 3.9 hr for controls. Of these, 42% vs. 27% of orders for cases vs. controls were empiric, 28% vs. 42% were < 4 hr, and 28% vs. 27% were > 4 hr. Candida albicans was the major organism identified (45.3% of cases, 54.6% of controls). Treatment agents selected included an azole in 57.4% of cases and 47.4% of controls, and an echinocandin in 33.3% and 27.3%, and a polyene in 5.7% and 27.8%.  No treatment was given in 1 case and 7 controls. Shared risk factors between groups included central venous catheters, antibiotic use, total parenteral nutrition, and stay in intensive care units.  

Conclusion: TTx and TRx were both shorter in the population that was evaluated by the surveillance service. Antifungal therapy was inappropriate in several patients who were not evaluated. These data suggest the presence of a yeast-in-blood surveillance service improves antifungal medication therapy initiation and choice, and consideration should be given to beginning or reinstating a similar program to achieve improved patient outcomes.


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

Speakers:
Kayla R. Stover, Pharm.D. , Department of Pharmacy Practice, University of Mississippi Medical Center, Jackson, MS
Rathel Nolan III, MD , University of Mississippi Medical Center, Jackson, MS
John Cleary, Pharm.D. , University of Mississippi, Jackson, MS

Disclosures:

K. R. Stover, None

R. Nolan III, None

J. Cleary, None

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