Can ID Consultations Decrease Candida Bloodstream Infection Mortality?

Infectious disease consultations in the hospital setting can improve patient outcomes for a variety of different infections, including Staphylococcus aureus, cryptococcosis, and other multidrug-resistant organisms.

Candida bloodstream infections are serious invasive infections that are associated with high mortality. In a new study a team of investigators set out to examine the relationship between infectious disease consultation and differences in management with mortality for Candida bloodstream infections.

The results of the study were published in The Lancet Infectious Diseases.

The retrospective, single-center cohort study was conducted at Barnes-Jewish Hospital in St. Louis, Missouri, a tertiary referral center. The investigators reviewed medical charts for all patients 18-years and older who were admitted to the hospital with a Candida bloodstream infection between 2002 and 2015.

Investigators assessed 90-day all-cause mortality between patients who did and did not receive an infectious disease consultation by evaluating demographics, comorbidities, predisposing factors, antifungal use, central-line removal, and data from ophthalmological and echocardiographic evaluations.

The study team also reports using Cox proportional hazards model with inverse weighting by propensity score for survival analysis to assess the effect of infectious disease consultation.

In total, 1794 individuals were evaluated for eligibility between January 1, 2002, and December 31, 2015. The investigators analyzed 1691 patients with Candida bloodstream infections, of whom 776 (45.9%) had an infectious disease consultation; the remaining 915 individuals (54.1%) did not have an infectious disease consultation.

The investigators included all 1691 patients in the analysis and observed that 90-day mortality was lower in the group who received infectious disease consultations when compared with the group who did not (29% [222 of out 776 patients ] vs 51% [468 out of 915 patients]; p<0·0001).

“In the model with inverse weighting by the propensity score, infectious disease consultation was associated with a hazard ratio of 0.81 (95% CI [confidence interval] 0.73—0.91; p<0·0001) for mortality,” the investigators wrote.

According to the report, most underlying comorbidities were evenly distributed between the groups, but in the group that received infectious disease consultation, the median duration of antifungal therapy was longer (18 [IQR 14—35] vs 14 [6—20] days; p<0.0001). The same was true for central-line removal (587 [76%] of 776 vs 538 [59%] of 915; p<0.0001), echocardiography use (442 [57%] of 776 vs 305 [33%] of 915; p<0.0001), and ophthalmological examination (412 [53%] of 776 vs 160 [17%] of 915; p<0.0001).

Additionally, it is reported that fewer patients in the infectious disease consultation group were not treated (13 [2%] of 776 vs 128 [14%] of 915; p<0.0001).

Based on these findings, the authors of the report conclude that patients with Candida bloodstream infections who received an infectious disease consultation had lower mortality.

“This finding might be attributable to these individuals receiving a higher number of non-pharmacological, evidence-based interventions and lower amounts of non-treatment,” the authors wrote, further concluding that the data suggest infectious disease consultations should be an integral part of candida bloodstream infection care.