Impact of infectious diseases consultation as a part of an antifungal stewardship programme on candidemia outcome in an Italian tertiary-care, University hospital

Abstract

Candidemia is a major cause of in-hospital mortality. Antifungal stewardship programme (AFSP) providing infectious diseases consultation (IDC) might improve the outcome. We evaluate the impact on candidemia mortality of IDC as part of AFSP restricting the use of all antifungals with exception of fluconazole. We retrospectively reviewed the charts of patients with documented candidemia in our hospital during the period 2012–2014 evaluating the impact of several variables on 30-days in-hospital mortality. We reviewed data on 276 patients with documented candidemia: 200 (72%) were treated without IDC and 76 (28%) with IDC. In the group without IDC, 52 patients (26%) received no antifungal therapy. Antifungals used for treating candidemia were (no IDC/IDC): azoles (74%/42%); echinocandins (0%/46%); liposomal and lipidic complex amphotericin B (0%/12%). The 30-day in-hospital mortality was respectively (no IDC/IDC) 37% vs. 20% (p = 0.011). The multivariate analysis confirmed IDC as independent factor protecting from death (OR 0.511, 95% CI 0.251–0.994; p = 0.046), together with fungemia due to non-albicans Candida (OR 0.565, 95% CI 0.327–0.977; p = 0.042). Age >65 years was associated with a higher risk of death (OR 1.989, 95% CI 1.055–3.895; p = 0.038). The additional cost for the use of echinocandins driven by IDC in the study period was €207,000. IDC, as a part of a restrictive front-end antimicrobial stewardship programme (ASP), providing a timely right choice of antifungal therapy, increases the cost of antifungal drugs but might be a contributing protective factor from mortality due to candidemia. Efforts to increase the number of IDC in patients with candidemia seems to be warranted.

Keywords:

• Antifungal stewardship
• program
• Candidemia
• Infectious diseases consultation
• Outcome

Acknowledgements

We thank Prof. Jon Cohen for the useful suggestions.

Conflict of interest

C.T. has received funds for speaking at symposia organized on behalf of Pfizer, Novartis, Merck and Astellas. No Conflict of Interest for the other authors.

Notes on contributors

Francesco Menichetti, Giacomo Bertolino, Carlo Tascini contributed to conception or design and revised the manuscript critically. Claudia Carmignani, Elena Rosselli Del Turco, Enrico Tagliaferri, Simona Barnini, Ielizza Desideri, Luana Dal Canto contributed to acquisition, analysis, or interpretation. Emanuela Sozio, Francesco Sbrana, Andrea Ripoli drafted the manuscript.