October 01, 2019
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ID consultation lowers mortality in patients with candidemia

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ANdrej Spec, MD
Andrej Spec

Infectious disease consultation was associated with lower mortality among patients with candida bloodstream infections during a recent 14-year period at one St. Louis hospital, according to results from a retrospective study.

“Many people have previously reported similar effects in small studies, and the pushback has always been about confounding in retrospective data. So, we undertook to analyze the data in such a way that it accounted for any possible confounders, given that a randomized controlled trial would be unethical,” Andrej Spec, MD, MSCI, assistant professor of medicine and associate director of the Infectious Disease Clinical Research Unit at Washington University School of Medicine in St. Louis, told Infectious Disease News.

Spec and colleagues reviewed the charts of patients admitted to Barnes-Jewish Hospital in St. Louis with candida bloodstream infections between Jan. 1, 2002, and Dec. 31, 2015. According to the study, they used a Cox proportional hazards model to assess the effects of infectious disease consultation on mortality.

“We limited the study to patients that survived more than 24 hours after the discovery of the infection and eliminated the highest and lowest risk tails of the data in order to minimize the confounding,” Spec explained. “This way we can feel comfortable increasing the involvement of infectious disease physicians in the care of patients with candidemia in order to reduce mortality.”

The researchers analyzed 1,691 patients with candida bloodstream infection, of which 45.9% had an infectious disease consultation and 54.1% did not. According to the study, 90-day mortality was lower among the infectious disease consultation group (29%) compared with patients who did not receive an infectious disease consultation (51%). Additional data showed that among the group that received infectious disease consultation, median duration of antifungal therapy was longer (18 days vs. 14 days) and central-line removal (76% vs. 59%), echocardiography use (57% vs. 33%), and ophthalmological examination (53% vs. 17%) were more frequently done, the researchers reported. In addition, fewer patients in the consultation group went untreated (2% vs. 14%).

According to Spec, the “topline result” is that, after extensive adjustment, infectious disease consultation was associated with a 19% survival benefit (HR = 0.81; 95% CI, 0.73-0.91) — a “dramatic effect,” he said.

“This difference is associated with more stringent implementation of interventions that have been associated with improved mortality in studies, such as removal of central lines, and ensuring that all patients are given therapy once candidemia is identified, even if they appear well,” he said. “Every patient with a candida in the blood should be treated, and they should be treated by an infectious disease physician.” – by Caitlyn Stulpin

Disclosures: Spec reports no relevant financial disclosures.