1036. Impact of Mandatory Infectious Diseases Consultation on Fungemia Management at a Large Academic Medical Center
Session: Poster Abstract Session: Antibiotic Stewardship: General Acute Care Implementation and Outcomes
Friday, October 28, 2016
Room: Poster Hall
Posters
  • Poster 1036 IDWeek 2016.pdf (288.3 kB)
  • Background: The incidence of invasive fungal infections (IFI) is increasing, and they are associated with substantial morbidity and mortality. While prompt, appropriate therapy has been shown to improve clinical outcomes, management is complex. Limited data are available describing the impact of infectious diseases (ID) consultation on outcomes. We sought to determine the impact of automatic ID consultation for all adult and pediatric inpatients with fungemia.

    Methods: This IRB-approved, retrospective cohort study compared the time to appropriate therapy (difference from first positive culture draw to first administration of appropriate therapy) before (November 2013 - October 2014 [control]) and after (November 2014 through October 2015 [intervention]) implementation of automatic ID consultation for inpatients <90yrs with fungemia. Secondary outcomes included infection-related length-of-stay, removal of central venous catheters, and performance of an ophthalmological exam. Groups were compared using t test for continuous data or Chi square for categorical data.

    Results: A total of 173 unique episodes of fungemia were included. Candida spp.were isolated in the majority (>90%) of episodes. The median time to appropriate therapy in the control and intervention groups was 51 hours and 50 hours in the control and intervention groups, respectively (p=0.6423). The proportion of patients that received an ophthalmological examination increased from 67% (control) to 86 % (intervention) (p=0.0046).

    Table. Comparison of Groups Pre- and Post-implementation of Automatic ID Consultation in Fungemic Patients at a Large Academic Medical Center

    Control

    n=94

    n (%)

    Intervention

    n=79

    n (%)

    p value

    Time to appropriate therapy (hours) - median (IQR)

    51 (32.5-74.8)

    50 (40-66)

    0.6423

    ID consultation

    84 (89.3)

    78 (98.7)

    0.0123

    Infection-related length-of-stay (days) - median (IQR)

    14 (7-20)

    16 (10-24)

    0.1561

    Time to removal of central venous catheter (days) - median (IQR)

    3 (2-5)

    3 (2-5)

    0.4289

    Ophthalmological exam

    63 (67.0)

    68 (86.0)

    0.0043

    Conclusion: Compliance with automatic ID consultation for patients with fungemia and improved performance of ophthalmological examinations were demonstrated.

    Travis Jones, PharmD1, Dustin Wilson, PharmD2, Christina Sarubbi, PharmD3, Deverick Anderson, MD, MPH, FIDSA, FSHEA4 and Richard H. Drew, PharmD, MS, BCPS, FCCP4, (1)Duke University Hospital, Durham, NC, (2)Duke University Medical Center, Durham, NC, (3)Pharmacy, Duke University Hospital, Durham, NC, (4)Division of Infectious Diseases, Duke University Medical Center, Durham, NC

    Disclosures:

    T. Jones, None

    D. Wilson, None

    C. Sarubbi, None

    D. Anderson, None

    R. H. Drew, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.