The interplay of infectious diseases consultation and antimicrobial stewardship in candidemia outcomes: A retrospective cohort study from 2016 to 2019

Abstract

Objective: To evaluate the need for mandatory infectious diseases consultation (IDC) for candidemia in the setting of antimicrobial stewardship guidance. Design: Retrospective cohort study from January 2016 to December 2019. Setting: Academic quaternary-care referral center. Patients: All episodes of candidemia in adults (n = 92), excluding concurrent bacterial infection or death or hospice care within 48 hours. Methods: Primary outcome was all-cause 30-day mortality. Secondary outcomes included guideline-Adherence and treatment choice. Guideline-Adherence was assessed with the EQUAL Candida score. Results: Of 186 episodes of candidemia, 92 episodes in 88 patients were included. Central venous catheters (CVCs) were present in 66 episodes (71.7%) and were the most common infection source (N = 38, 41.3%). The most frequently isolated species was Candida glabrata (40 of 94, 42.6%). IDC was performed in 84 (91.3%) of 92 candidemia episodes. Mortality rates were 20.8% (16 of 77) in the IDC group versus 25% (2 of 8) in the no-IDC group (P =.67). Other comparisons were numerically different but not significant: repeat blood culture (98.8% vs 87.5%; P =.17), echocardiography (70.2% vs 50%; P =.26), CVC removal (91.7% vs 83.3%; P =.45), and initial echinocandin treatment (67.9% vs 50%; P =.44). IDC resulted in more ophthalmology examinations (67.9% vs 12.5%; P =.0035). All patients received antifungal therapy. Antimicrobial stewardship recommendations were performed in 19 episodes (20.7%). The median EQUAL Candida score with CVC was higher with IDC (16 vs 11; P =.001) but not in episodes without CVC (12 vs 11.5; P =.81). Conclusions: In the setting of an active antimicrobial stewardship program and high consultation rates, mandatory IDC may not be warranted for candidemia.