Background Candidaemia/invasive candidiasis are becoming emerging problems in hospital practice due to an increased prevalence of susceptible hosts, i.e. patients with central venous catheters and/or immunosuppressive therapies added to a broad-spectrum antibiotic therapy. It is essential to identify risk factors for attributable mortality and to set up a stewardship programme to improve infection management.
Purpose The objective of this study was to compare clinical outcomes of patients with candidaemia before and after implementation of an antifungal stewardship programme (AFSP).
Material and methods All consecutive cases of candidaemia were included from January 2012 to December 2015 in a University Hospital. Data were collected retrospectively for a period of 2 years before implementation of the AFSP, and prospectively 2 years after. All cases were reviewed by a multidisciplinary panel of experts including two infectious disease physicians, a microbiologist and two pharmacists in order to have a complete follow-up of patients.
Results Seventy patients were included. Patients were more often male (sex ratio M/F: 2.5) with a median age of 65.5 years (52–78). The sites of entry for candidaemia were: intraabdominal in 29 cases (41.4%), central venous catheter in 21 (30.0%) and other or unknown in 20 (28.6%). The most frequent comorbidities were malignancy (n=36; 51.4%) and renal failure (n=21; 30%). Sixty-one patients (87.1%) had a central venous catheter and 18 (25.7%) had abdominal surgery. Infectiologist consultations increased from 36.4% to 86.5% between the two periods, with a significant impact on daily blood cultures which were more frequently performed in the second period (p=0.04). Echinocandin use was also more frequent in the second period (97.1% vs 78.8%, p=0.03). The 3 month mortality rate declined from 36.4% in the first period to 27.0% in the second period.
Conclusion The strengths of this AFSP is its duration and the number of patients. Unfortunately, our study lacked statistical power to show a significant impact on mortality. A decline tendency was observed in mortality rates but efforts concerning candidaemia management must be maintained.
References and/or acknowledgements No conflict of interest.