1437. Impact of a Care Bundle for the Management and Outcomes of Candidemia in Patients with Solid Organ Tumors
Session: Poster Abstract Session: Fungal Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • IDSA_Final_Candidemia.pdf (153.5 kB)
  • Background: Candidemia causes substantial morbidity and mortality. A recent study suggested that a comprehensive care bundle improved the management of patients with candidemia, but its effect is unclear in other institutional settings. The purpose of this study is to assess the impact of a care bundle on the management and outcomes of candidemia in patients with solid organ tumors.

    Methods: Routine direct intervention with infectious diseases specialists for all cases of candidemia was initiated at an 800-bed cancer and infectious disease center in Japan. Medical records of all patients with candidemia and solid organ tumors were reviewed during the period of January 2001 through March 2013. We compared the management and outcomes of candidemia before and after the intervention. A candidemia care bundle was developed at our institution based on the guideline recommendations from the Infectious Diseases Society of America. Bundle elements were as follows: (1) Removal of intravenous catheters. (2) Repeat blood cultures. (3) Ophthalmologic consultation. (4) Selection of effective antifungal agents with appropriate dosage and duration of use.

    Results: Before and after the implementation of routine intervention, 50 and 28 cases of candidemia were evaluated, respectively. Patient demographic and clinical characteristics were similar between the groups. The most commonly isolated species were Candida albicans, C. glabrata, and C. parapsilosis. Adherence with all care bundle elements was significantly higher in the intervention group (64.3% versus 6.0%, P<.001). Routine intervention improved rates of repeat blood cultures (82.1% versus 38.0%, P<.001), ophthalmologic consultation (71.4% versus 18.0%, P<.001), and selection of effective antifungal agents with appropriate dosage and duration of use (78.6% versus 18.0%, P<.001). Thirty-day mortality tended to be lower in the intervention group, but the difference was not statistically significant (21.4% versus 40.0%, P=.15).

    Conclusion: A candidemia care bundle implemented by infectious diseases specialists improved adherence to standards of care in patients with solid organ tumors.

    Noritaka Sekiya, MD, Clinical Microbiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan


    N. Sekiya, None

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