Multicenter Study of the Effectiveness of Antifungal Stewardship Team Intervention for Candidemia in Japan in 2008–2021
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients and Fungal Isolates
2.2. Antimicrobial Stewardship Programs
2.3. Clinical Parameters
2.4. Statistical Analysis
3. Results
3.1. Patient Background and Candida Species
3.2. Antifungal Drugs Received by Patients
3.3. Effects of AFT Intervention
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
References
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(A) | ||||||||
Total = 204 | Pre-Intervention Group = 120 | Post-Intervention Group = 84 | p Value | |||||
n | % | n | % | n | % | |||
Characteristics of patients | ||||||||
Age, median, years | 72 | 74 | 71 | 0.82 ‡ | ||||
Male sex | 133 | 65.2 | 79 | 65.8 | 54 | 64.3 | 0.88 † | |
Gastrointestinal disease | 82 | 40.2 | 51 | 42.5 | 31 | 36.9 | 0.47 † | |
Diabetes mellitus | 54 | 26.5 | 27 | 22.5 | 27 | 32.1 | 0.15 † | |
skin disease | 31 | 15.2 | 23 | 19.2 | 8 | 9.5 | 0.07 † | |
Blood disease | 27 | 13.2 | 18 | 15.0 | 9 | 10.7 | 0.41 † | |
Urological disease | 20 | 9.8 | 13 | 10.8 | 7 | 8.3 | 0.64 † | |
Collagen disease | 10 | 4.9 | 5 | 4.2 | 5 | 6.0 | 0.74 † | |
Febrile neutropenia | 12 | 5.9 | 8 | 6.7 | 4 | 4.8 | 0.77 † | |
Receiving steroids or immunosuppressive drugs | 65 | 31.9 | 38 | 31.7 | 27 | 32.1 | 1.00 † | |
Anticancer drug | 41 | 20.1 | 24 | 20.0 | 17 | 20.2 | 1.00 † | |
Radiation therapy | 13 | 6.4 | 7 | 5.8 | 6 | 7.1 | 0.78 † | |
Required full assistance with ADLs | 93 | 45.6 | 44 | 36.7 | 49 | 58.3 | <0.01 † | |
Use of central venous catheter | 161 | 78.9 | 94 | 78.3 | 67 | 79.8 | 0.86 † | |
CRBSI | 89 | 43.6 | 43 | 35.8 | 46 | 54.8 | <0.01 † | |
Use of urinary catheters | 162 | 79.4 | 95 | 79.2 | 67 | 79.8 | 1.00 † | |
Intravital devices | 158 | 77.5 | 95 | 79.2 | 63 | 75.0 | 0.50 † | |
Administration of high-calorie infusions | 144 | 70.6 | 88 | 73.3 | 56 | 66.7 | 0.35 † | |
Received surgery | 96 | 47.1 | 57 | 47.5 | 39 | 46.4 | 0.89 † | |
Number of days until blood culture results are known | 3.3 | 3.4 | 3.2 | 0.42 ‡ | ||||
Patients who did not receive antifungal drugs | 13 | 6.4 | 11 | 9.2 | 2 | 2.4 | 0.08 † | |
The average time to change the drug due to inadequate efficacy | 12 | 12.9 | 9.4 | 0.25 ‡ | ||||
Frequency of candidemia | 0.15 | 0.15 | 0.16 | 0.57 † | ||||
(number of positive sets/numbers of total sets*100) | ||||||||
Candidemia patients per 1000 new admissions | 0.47 | 0.4 | 0.62 | <0.01 † | ||||
Compliance with the action bundle | ||||||||
Collection of two sets of blood cultures | 121 | 59.3 | 55 | 45.8 | 66 | 78.6 | <0.01 † | |
Removing intravital devices | 124 | 66.7 (total = 186) | 66 | 59.5 (total = 111) | 58 | 77.3 (total = 75) | 0.01 † | |
Appropriate antifungal therapy | 179 | 87.7 | 105 | 87.5 | 74 | 88.1 | 1.00 † | |
Consulting an ophthalmologist | 106 | 52.0 | 42 | 35.0 | 64 | 76.2 | <0.01 † | |
Ophthalmology re-examination | 37 | 34.9 (total = 106) | 11 | 26.2 (total = 42) | 26 | 40.6 (total = 64) | 0.15 † | |
Follow-up blood cultures until clearance of candidemia | 147 | 72.1 | 68 | 56.7 | 79 | 94.0 | <0.01 † | |
Scrutiny of organ involvement when blood cultures are consecutively positive | 33 | 64.7 (total = 51) | 15 | 57.7 (total = 26) | 18 | 72.0 (total = 25) | 0.38 † | |
(B) | ||||||||
30-day mortality rate | 58 | 28.4 | 41 | 34.2 | 17 | 20.2 | 0.04 † | |
C. albicans | 90 | 44.1 | 56 | 46.7 | 34 | 40.5 | 0.47 † | |
C. parapsilosis | 54 | 26.5 | 31 | 25.8 | 23 | 27.4 | 0.87 † | |
C. glabrata | 25 | 12.3 | 12 | 10.0 | 13 | 15.5 | 0.28 † | |
C. tropicalis | 17 | 8.3 | 9 | 7.5 | 8 | 9.5 | 0.62 † | |
C. guilliermondii | 7 | 3.4 | 6 | 5.0 | 1 | 1.2 | 0.25 † | |
C. lustaniae | 4 | 2.0 | 1 | 0.8 | 3 | 3.6 | 0.31 † | |
C. krusei | 3 | 1.5 | 3 | 2.5 | 0 | 0.0 | 0.27 † | |
C. dubliniensis | 1 | 0.5 | 1 | 0.8 | 0 | 0.0 | 1.00 † | |
C. famata | 1 | 0.5 | 1 | 0.8 | 0 | 0.0 | 1.00 † | |
C. duobshaemulonii | 1 | 0.5 | 0 | 0.0 | 1 | 1.2 | 0.41 † | |
C. metapsilosis | 1 | 0.5 | 0 | 0.0 | 1 | 1.2 | 0.41 † |
Echinocandins Group = 106 | Nonechinocandin Drugs Group = 85 | p Value | |
---|---|---|---|
30-day mortality rate | 28.3 | 27.1 | 0.87 † |
serum creatinine level (median) | 0.77 | 0.99 | 0.04 ‡ |
Odds Ratio | p Value | |
---|---|---|
Collection of two sets of blood cultures | 0.88 | 0.72 |
Consulting an ophthalmologist | 0.52 | 0.13 |
Follow-up blood cultures until clearance of candidemia | 0.23 | <0.01 |
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Tokano, M.; Tarumoto, N.; Sakai, J.; Imai, K.; Koizumi, S.; Karaushi, H.; Hatanaka, T.; Kishi, E.; Seki, M.; Mitsutake, K.; et al. Multicenter Study of the Effectiveness of Antifungal Stewardship Team Intervention for Candidemia in Japan in 2008–2021. Infect. Dis. Rep. 2024, 16, 356-366. https://doi.org/10.3390/idr16020027
Tokano M, Tarumoto N, Sakai J, Imai K, Koizumi S, Karaushi H, Hatanaka T, Kishi E, Seki M, Mitsutake K, et al. Multicenter Study of the Effectiveness of Antifungal Stewardship Team Intervention for Candidemia in Japan in 2008–2021. Infectious Disease Reports. 2024; 16(2):356-366. https://doi.org/10.3390/idr16020027
Chicago/Turabian StyleTokano, Mieko, Norihito Tarumoto, Jun Sakai, Kazuo Imai, Sakaru Koizumi, Haruka Karaushi, Tamotsu Hatanaka, Etsuko Kishi, Masafumi Seki, Koutaro Mitsutake, and et al. 2024. "Multicenter Study of the Effectiveness of Antifungal Stewardship Team Intervention for Candidemia in Japan in 2008–2021" Infectious Disease Reports 16, no. 2: 356-366. https://doi.org/10.3390/idr16020027
APA StyleTokano, M., Tarumoto, N., Sakai, J., Imai, K., Koizumi, S., Karaushi, H., Hatanaka, T., Kishi, E., Seki, M., Mitsutake, K., & Maesaki, S. (2024). Multicenter Study of the Effectiveness of Antifungal Stewardship Team Intervention for Candidemia in Japan in 2008–2021. Infectious Disease Reports, 16(2), 356-366. https://doi.org/10.3390/idr16020027