Impact of Infectious Disease Consultation in Patients With Candidemia: A Retrospective Study, Systematic Literature Review, and Meta-analysis

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Morbidity and mortality from candidemia remain unacceptably high. While infectious disease consultation (IDC) is known to lower the mortality from Staphylococcus aureus bacteremia, little is known on the impact of IDC in candidemia.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>We conducted a retrospective observational cohort study of candidemia patients at a large tertiary care hospital between 2015 and 2019. The crude mortality rate was compared between those with IDC and without IDC. Then, we systematically searched five databases through February 2020 and performed a meta-analysis of the impact of IDC on mortality of patients with candidemia.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>A total of 151 patients met the inclusion criteria, 129 (85%) of whom received IDC. Thirty-day, and 90-day mortality rates were significantly lower in the IDC group (18% vs 50%, P = .002; 23% vs 50%, P = .0022, respectively). Systematic literature review returned 216 reports, of which, 13 studies including the present report fulfilled the inclusion criteria. Among the 13 studies with a total 3687 patients, IDC was performed in 49% of patients. Overall mortality was 38.2% with a significant difference in favor of the IDC group (28.4% vs. 47.6%) with a pooled relative risk of 0.41 [95% Cl 0.35-0.49]. Ophthalmology referral, echocardiogram, and central line removal were performed more frequently among patients receiving IDC.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>This study is the first systematic literature review and meta-analysis to evaluate the association between IDC and candidemia mortality. IDC was associated with significantly lower mortality and should be considered in all patients with candidemia.</jats:p> </jats:sec>

Trends in the Epidemiology of Candidemia in Intensive Care Units From 2006 to 2017: Results From the Korean National Healthcare-Associated Infections Surveillance System

“…According to the IDSA recommendations, a safe and effective prophylactic strategy, including appropriate antifungal use to prevent candidemia among high-risk patients and daily bathing with chlorhexidine could be considered ( 24 ). Infectious disease consultation is one of the best-proven ways to lower patients' mortality rates with candidemia ( 25 ).…”

Consensus guidelines for the diagnosis and management of invasive candidiasis in haematology, oncology and intensive care settings, 2021

“…227,253 Higher rates of assessment for, and treatment of, complications of candidaemia were reported by Kobayashi et al, with increased rates of ophthalmological examination (pooled OR 6.1), echocardiogram (pooled OR 3.01) and CVC removal (pooled OR 3.27). 252 Two studies have reported that infectious diseases consultation reduced time to appropriate therapy and was associated with more rapid resolution of fungaemia. 230,254 In several studies, infectious diseases consultation was associated with higher rates of diagnosis of endocarditis or endophthalmitis.…”

“…Infectious diseases consultation has been demonstrated to significantly improve mortality at 30, 230,252,253 60 230 and 90 days, 227,252 and overall survival. 254 A recent meta-analysis 252 of 10 studies found a reduction in mortality from 47.6% to 28.4% (pooled OR 0.41).…”

The impact of infectious diseases consultation on the management and outcomes of Pseudomonas aeruginosa bacteraemia in adults: a retrospective cohort study

“…Infectious diseases specialist consultation (IDC) is associated with improved clinical outcome in patients with Staphylococcal aureus bacteraemia, resulting in reduced mortality [13][14][15][16][17], lower treatment failure rates [18], better adherence to guidelines [13,15], lower antimicrobial resistance development [15], higher probability of identifying a removable focus of bacteraemia [14,16] and higher likelihood of patients receiving appropriate empiric and directed antimicrobial therapies for an appropriate duration [14,15]. Infectious diseases specialist consultation was also shown to reduce mortality in multidrug-resistant organism infection [19], candidemia [20,21], cryptococcal infection [22] and enterococcal bacteraemia [23,24].…”