Impact of Automated Cellphone Text Message Notification for Positive Blood Culture on the Outcome of Candidemia: a Multicenter, Pre-post Quasi-experimental Study

Background: Rapid intervention significantly impacts a prognosis of candidemia in hospitalized patients. Automated cellphone text messaging system (ACTMS) is anticipated to allow fast acknowledgement of positive blood culture and early initiation of antifungal therapy. In this study, we analyzed whether the ACTMS shortens the time to initiate antifungal therapy and improve the outcome of candidemia.

Methods: This retrospective, multi-center, pre- post quasi-experimental study was conducted at 5 university-affiliated hospitals in Korea. From 2007 to 2013, adult patients over 18 years of age with candidemia reported via the ACTMS were compared to historical controls with candidemia reported via the conventional system.

Results: A total of 573 patients (251 of the pre-ACTMS period and 322 of the post-ACTMS period) were included. Baseline characteristics showed no differences between the pre- and post- ACTMS period. Antifungal therapy was administered in 58.2% (146 of 251) and 69.3% (223 of 322) of patients in the pre- and post-ACTMS period, respectively (p=0.004). The median time to initiate antifungal therapy was shortened by over 34 hours in the post-ACTMS period (median 117.4 hours [interquartile range, IQR 88.1-171.9] vs. 83.0 hours [IQR 61.0-125.1], p<0.001). Compared to the pre-ACTMS period, a greater number of patients received antifungal therapy within 96 hours (36.9% vs. 55.9%, p=0.002). However, overall and candidemia-related mortality were not significantly different between the two periods. After excluding patients who were not administered antifungal agents or died within 2 days from the time of blood culture, candidemia-related death was 18.5% (27 of 146) and 13.4% (29 of 217) in the pre- and post ACTMS group (p=0.238). Interrupted time series analysis showed that the ACTMS did not improve candidemia-related mortality (p=0.593).

Conclusion: The ACTMS that sends short messages directly to a doctor’s cellphone significantly shortens the time to initiate antifungal therapy. However, there was no significant impact on candidemia-related mortality. Further improvement in the outcome of candidemia is to be expected through efficient use of this ACTMS and simultaneous improvement of variable therapeutic measures.