Candidemia: systematic management can save lives

  • Murri R & al.
  • J Infect
  • 6 May 2018

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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.

Study design

  • 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.

Limitations

  • Nongeneralizable findings.
  • No consensus on most useful clinical elements for survival.
  • Study design limits conclusion.

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