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. 2020 Mar;9(1):119-135.
doi: 10.1007/s40121-020-00281-x. Epub 2020 Feb 4.

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

Antonio Vena  1   2   3   4 , Emilio Bouza  1   2   4   5 , Rafael Corisco  1 , Marina Machado  1   2   4 , Maricela Valerio  1   2   4 , Carlos Sánchez  1 , Patricia Muñoz  6   7   8   9 ; COMIC Study Group
Affiliations

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

Antonio Vena et al. Infect Dis Ther. 2020 Mar.

Abstract

Introduction: To evaluate the clinical impact of a comprehensive care bundle for the management of candidemia.

Methods: A quasi-experimental pre-post study was implemented. During the pre-intervention period (May 2014-September 2015), a non-mandatory antifungal stewardship program (ASP) was implemented, and patients with candidemia were visited by an infectious disease specialist who provided diagnostic and therapeutic advice according to standard of care as soon as possible. During the post-intervention period (October 2015-May 2017), patients were managed according to a candidemia care bundle with clear and structured recommendations written in their medical history.

Results: Overall, 109 patients were included, 56 in the pre-intervention and 53 in the post-intervention period. Overall, compliance with the Candida bundle significantly improved between the pre- [27/56 (48.2%)] and post-intervention [43/53 (81.1%); p = 0.01] period. Individual bundle components that significantly improved in the post-intervention period were early adequate antifungal therapy [47/56 (83.9%) vs. 51/53 (96.2%), p = 0.05], early adequate source control of the infection [37/56 (82.2%) vs. 41/53 (97.6%), p = 0.03] and appropriate duration of therapy [27/56 (48.2%) vs. 43/53 (81.1%), p = 0.01]. Adherence to follow-up blood cultures, ophthalmologic examination and echocardiography improved in the post-intervention period, but the difference was not statistically significant. Multivariate analysis revealed that being managed according to candidemia bundle had a favorable impact on 14-day mortality (HR 0.08, 95% CI 0.01-0.45, p = 0.02) and 30-day mortality (HR 0.40, 95% CI 0.18-0.89, p = 0.02).

Conclusions: A simple bundle focused on increasing adherence to a few evidence-based interventions contributed to a significant reduction in 14- and 30-day mortality in patients with candidemia.

Keywords: Antifungal stewardship; Bundle; Candida; Candidemia; Outcome; Quality of care.

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Figures

Fig. 1
Fig. 1
Flow chart of patients included in the study
See this image and copyright information in PMC

References

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