- Appropriate management of candidemia (i.e., therapeutic and nontherapeutic care aspects) appears to substantially improve survival.
Why this matters
- Candidemia mortality rates range from 35% to 75%.
- Several strategies appear to improve outcomes, including: 1) initiating appropriate initial therapy (antifungal agent with known in vitro activity against Candida spp. ≤48 hours), 2) follow-up blood culture ≤14 days postdiagnosis, 3) transthoracic and/or transesophageal echocardiography, 4) ophthalmological examination, 5) timely central venous catheter (CVC) removal.
- Familiarity with European Society of Clinical Microbiology and Infectious Diseases and Infectious Disease Society of America Candida guidelines is warranted.
- 213 enrolled patients.
- Only 16.9% (n=36) received/achieved 5 clinical care measures, whereas 37.1% and 28.2%, respectively, received 4 and 3.
- 73.7% (n=157) achieved all 3 early measures (i.e., initial therapy, CVC, follow-up blood culture).
- Implementation of at least 3 appropriate clinical measures was associated with improved survival (HR, 0.39; 95% CI, 0.30-0.52; P<.01>
- Mortality risk was inversely related to increasing numbers of appropriate measures achieved.
- Prospective, observational, monocentric cohort evaluation to determine if achieving increased number of guideline-driven, appropriate clinical management elements improves clinical outcomes in candidemia.
- Funding: None.
- Nongeneralizable findings.
- No consensus on most useful clinical elements for survival.
- Study design limits conclusion.