Efficacy of a “Checklist” Intervention Bundle on the Clinical Outcome of Patients with Candida Bloodstream Infections: A Quasi-Experimental Pre-Post Study

Vena, Antonio; Bouza, Emilio; Corisco, Rafael; Machado, Marina; Valerio, Maricela; Fresno, Carlos del

doi:10.1007/s40121-020-00281-x

Cited by 24 publications

(33 citation statements)

References 25 publications

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“…IDE consultation was also associated with a better antifungal prescription according to Valerio's score. Our results are in line with those described by other authors in centres similar to ours 20‐23 as well as studies carried out in different scenarios, including Asian and American countries 13‐16 . All these data add to the growing body of evidence that supports the need for an early systematic IDE consultation (as opposed to on‐demand IDE consultation) and antifungal stewardship programmes in tertiary centres with complexity similar to ours.…”

Section: Discussionsupporting

confidence: 92%

A retrospective validation of different scores of guideline adherence and infectious diseases consultation on candidaemia: The higher, the better

Calderón-Parra

Herraiz-Jiménez

Ramos‐Martínez

et al. 2021

Mycoses

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Background Recently, several scores to quantify compliance with the guidelines in candidaemia management (EQUAL, GEMICOMED, Valerio) have been developed. Evidence supporting the association of these scores to the prognosis is scarce. We aim to evaluate the performance of these candidaemia guideline adherence scores to predict candidaemia outcome. Methods We recorded retrospectively data from candidaemia episodes (January 2017‐December 2018). We analysed adherence to guidelines for candidaemia management according to EQUAL, GEMICOMED and Valerio scores, and we correlated those to outcome. Results Fifty‐four first episodes of candidaemia were retrieved. Five patients who died in the first 48 hours after blood cultures were not included. Thirty‐day mortality in evaluable patients was 18.4%. Median adherence to guidelines according to EQUAL score was 17 (interquartile range [IQR]: 15‐19), and according to GEMICOMED was 86% (IQR: 72.5%‐100%). According to Valerio score, adequacy of antifungal prescription was 8.5/10 (SD: 1.9). A cut‐off of ≥17 for EQUAL or compliance >70% for GEMICOMED was associated with inferior 30‐day mortality (7.1% vs 33.3%, P = .028 and 7.9% vs 54.5%, P = .002, respectively). Infectious diseases (ID) evaluated cases obtained a better EQUAL score (>17; 82.1% vs 42.9%, P = .006), had inferior 30‐day mortality (9.4% vs 35.3%, P = .049) and a better antifungal prescription adequacy (Valerio score 9.0 vs 7.5, P = .011). Conclusion Adherence to guidelines for candidaemia management evaluated by means of EQUAL and GEMICOMED score was associated with a decreased 30‐day mortality. Adequacy of antifungal prescription can be ameliorated. ID consultation improved guideline adherence and was associated with decreased 30‐day mortality.

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Section: Discussionsupporting

confidence: 92%

A retrospective validation of different scores of guideline adherence and infectious diseases consultation on candidaemia: The higher, the better

Calderón-Parra

Herraiz-Jiménez

Ramos‐Martínez

et al. 2021

Mycoses

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“…Recommendations for ancillary management measures in candidaemia are included in the Australian, 40 US 41 and European 42 guidelines and include requirement for early CVC removal, ophthalmological consultation, echocardiography, repeat blood cultures and a 14 day duration of therapy following clearance of blood cultures. Strategies to improve adherence to candidaemia guideline recommendations, including timely initiation of appropriate antifungals and implementation of a bundle of care, have been shown to improve patient outcomes 18,[43][44][45][46] including a demonstrated mortality benefit. 43,44 Pettit et al 25 implemented the most extensive bundle of care incorporating all recommended management strategies in addition to the requirement for infectious diseases consultation.…”

Section: Discussionmentioning

confidence: 99%

The impact of pharmacist‐led antifungal stewardship interventions in the hospital setting: a systematic review

Khanina

Cairns

Kong

et al. 2021

Pharmacy Practice and Res

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Aim: To summarise the evidence on pharmacist-led antifungal stewardship (AFS) programs in the hospital setting and to evaluate their impact on the quality of antifungal prescribing and infection management, antifungal usage and clinical outcomes. Data sources: A systematic review of English-language studies identified in MEDLINE and EMBASE was performed on 27 November 2020 and conducted in accordance with PRISMA. Search terms included 'antifungal agent', 'invasive fungal infection', 'antimicrobial stewardship', 'patient care bundles' and 'pharmacist'. Study selection: Eligible studies describing pharmacist-led quality improvement intervention(s) implemented in the hospital setting targeted at optimising systemic antifungal prescribing. Results: Six hundred and forty-six studies were identified, and seven met inclusion criteria. Five were dedicated to optimising candidaemia management, one at optimising intensive care unit prescribing of caspofungin and one on antifungal prescribing in haematology and oncology units. All studies measured varied metrics relating to quality of prescribing and infection management, reporting improvement in proportion of effective antifungal therapy (n = 1/1), appropriate antifungal selection (n = 1/1), dosing (n = 2/3), management of drug-drug interactions (n = 1/1) and reduced time to antifungal initiation (n = 4/4). Studies that implemented a candidaemia bundle of care reported improvements in composite bundle adherence (n = 2/2), with greatest improvement in ophthalmological consultation (n = 4/4), echocardiography (n = 2/2) and infectious diseases consultation (n = 3/3). There was reduction in antifungal expenditure (n = 4/4) and consumption (n = 2/4). Pharmacist-led AFS programs did not influence clinical outcomes. Conclusion: Available evidence suggests that pharmacist-led AFS interventions can improve the quality and timeliness of antifungal prescribing and reduce antifungal usage. Further research is required to assess the impact on clinical and microbiological outcomes.

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“…Recent systematic reviews of AFS studies have highlighted that most interventions rely heavily on prospective audit and feedback and preauthorization [ 15 , 16 ]. Many of the studies included in these systematic reviews and those published elsewhere have focused on patients with candidemia in the intensive care unit (ICU) [ 2 , 17 , 18 , 19 ]. These interventions commonly involve “care bundles” or “checklists” of best practices prioritizing early detection and diagnosis, early initiation of antifungal therapy, and source control.…”

Section: Antifungal Stewardship Interventionsmentioning

confidence: 99%

“…While these interventional studies in candidemia have demonstrated increased compliance with elements of the care bundle and reduced antifungal consumption, few have demonstrated improvements in clinical outcomes. A notable exception is a recently published single-center, quasi-experimental pre-post study that demonstrated a significant reduction in 14- and 30-day all-cause mortality after implementation of a care bundle in patients with candidemia [ 19 ].…”

Section: Antifungal Stewardship Interventionsmentioning

confidence: 99%

The Current State of Antifungal Stewardship in Immunocompromised Populations

Alegria

Patel

2021

JoF

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Inappropriate antifungal use is prevalent and can lead to drug-resistant fungi, expose patients to adverse drug events, and increase healthcare costs. While antimicrobial stewardship programs have traditionally focused on antibiotic use, the need for targeted antifungal stewardship (AFS) intervention has garnered interest in recent years. Despite this, data on AFS in immunocompromised patient populations is limited. This paper will review the current state of AFS in this complex population and explore opportunities for multidisciplinary collaboration.

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Efficacy of a “Checklist” Intervention Bundle on the Clinical Outcome of Patients with Candida Bloodstream Infections: A Quasi-Experimental Pre-Post Study

Cited by 24 publications

References 25 publications

A retrospective validation of different scores of guideline adherence and infectious diseases consultation on candidaemia: The higher, the better

A retrospective validation of different scores of guideline adherence and infectious diseases consultation on candidaemia: The higher, the better

The impact of pharmacist‐led antifungal stewardship interventions in the hospital setting: a systematic review

The Current State of Antifungal Stewardship in Immunocompromised Populations

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