Management bundles for candidaemia: the impact of compliance on clinical outcomes

Abstract

ObjectivesThe Mycoses Forum in Japan has developed management bundles for candidaemia to incorporate into bedside practice. The aim of this study was to investigate nationwide compliance with the bundles and their impact on clinical outcomes.MethodsNon-neutropenic patients treated with antifungals for candidaemia were surveyed. Bundles consist of nine items to complete. Data were sent to the central office between July 2011 and April 2012.ResultsSix hundred and eight patients were analysed. The compliance rate for achieving all elements was 6.9%, and it increased to 21.4% when compliance was analysed by the bundle except for oral switch. There was a significant difference in clinical success between patients with and without compliance [92.9% versus 75.8% (P = 0.011)]. Compliance with the bundles, however, failed to be an independent factor associated with favourable outcomes. When step-down oral therapy was excluded from the elements of compliance, compliance with the bundles was revealed to be an independent predictor of clinical success (OR 4.42, 95% CI 2.05–9.52) and mortality (OR 0.27, 95% CI 0.13–0.57). Independent individual elements contributing to clinical success were removal of central venous catheters within 24 h, assessment of clinical efficacy on the third to the fifth day and at least 2 weeks of therapy after clearance of candidaemia.ConclusionsCompliance with the bundles for candidaemia had a beneficial effect on clinical outcomes. Promotion of the bundles approach may have the potential to narrow the gap between clinical evidence and bedside practice.

Prognostic factors for candidaemia in intensive care unit patients: a retrospective analysis

“…(25) There are three possible reasons for the higher mortality rate seen among our patients. First, our study included many severely ill patients (mean APACHE II score 20.5, mean SOFA score 11.2).…”

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

“…To our knowledge, this study is one of the largest and most inclusive study evaluating the clinical impact of a checklist care bundle for management of patients with candidemia. However, many published studies have described individual aspects of the bundle being associated with better prognosis (i.e., early adequate antifungal administration or adequate source control) [6][7][8][9]; only three recent studies have addressed the impact of a bundle approach on the management of patients with candidemia [18][19][20]. Antworth et al [18] conducted a single-center study of 78 patients with candidemia and demonstrated improved compliance with all candidemia care bundle elements, but not significant differences in clinical outcome.…”

“…Takesue and colleagues [19] performed a nationwide study of 608 patients with candidemia to investigate compliance with their bundle and its impact on mortality. Unfortunately, study participation by infection control doctors was entirely voluntary, and the candidemia bundle was not systematically implemented in all candidemic patients.…”

Impact of host- and early treatment-related factors on mortality in ICU patients with candidemia: a bicentric retrospective observational study

“…Appropriate antifungal therapy was defined as the administration of the correct dose of antifungal agent for a susceptible Candida species. Correct doses of antifungal agents were defined as follows: caspofungin, loading dose of 70 mg, then 50 mg daily; micafungin, 100-150 mg daily; liposomal amphotericin B, 2.5-5 mg/kg daily; fluconazole, loading dose of 800 mg (or 12 mg/kg), then 400 mg (or 6 mg/kg) daily; fosfluconazole, loading dose of 800 mg (or 12 mg/kg) daily for 2 days, then 400 mg (or 6 mg/kg) daily; and voriconazole, loading dose of 400 mg (or 6 mg/kg) twice daily for 2 doses, then 200-300 mg (or 3-4 mg/kg) twice daily [7,8]. Antifungal susceptibility was determined using the guidelines in the Clinical and Laboratory Standard Institute document M27-S3 [9].…”