Reducing Candidemia Mortality Through ID Physician Consults
Saskia v. Popescu, PhD, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist. During her work as an infection preventionist, she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She holds a doctorate in Biodefense from George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in Infection Control and has worked in both pediatric and adult acute care facilities.
Candidemia is the fourth most common health care-associated infection. To improve hospitalized patients’ safety, infectious disease physicians should be consulted.
Fungal infections have been a hot topic of conversation in the world of infectious diseases and infection prevention. The growing global threat of Candida auris, which was heavily discussed at last week’s IDWeek 2019, has many concerned about the prevalence of these infections and considerable gaps in surveillance.
For hospitalized patients, the concern for infections related to invasive medical devices (central lines, Foley catheters, etc.) is very real. Bloodstream infections are a serious concern for patients and infection preventionists alike. Unfortunately, Candida fungal infections are all too common in the bloodstream. It is estimated that there are 25,000 bloodstream infections related to Candida annually in the United States and that roughly 40% of those patients ultimately die from the infection.
For health care-associated infections, candidemia is the 4th most common. Treatment often involves Fluconazole, but studies have shown increased use of liposomal amphotericin B, micafungin and voriconazole. In a review of 11,273 hospital admissions and 115 patients with candidemia, investigators found that while empirical therapy was started within 24 hours of a blood culture in 44% of patients, only 81.7% of those treated had adequate treatment as confirmed by antifungal susceptibility testing. These findings drive home the importance of having infectious disease physicians consulting on patients with fungal infections.
New research from the Washington University School of Medicine in St. Louis, published in The Lancet Infectious Diseases, actually found that when an infectious disease physician oversaw care of a patient with candidemia, the mortality rate declined by 20% .
"Candida infections are a major problem in hospitals large and small across the country," said senior author Andrej Spec, MD, an assistant professor of medicine and associate director of the university's Infectious Diseases Clinical Research Unit and director of the university's Invasive Fungal Infections Clinic in a statement. "Even uncomplicated versions of these infections are actually quite dangerous and require a detailed and well-thought-out approach to make sure that people do well. Infectious disease doctors are the ones who have the expertise to best treat these infections."
The researchers of this study analyzed data from 1691 patients with candidemia treated from 2002-2015. Within each case, they assessed what medical providers did to help provide care, treat the infection, whether they consulted with an infectious disease physician, and the percentage of patients living 90 days after the diagnosis. Following this analysis, they found that 45.9% of the physicians primarily responsible for the patient consulted with an infectious disease physician.
Among patients, 28.6% died within 90 days, while the mortality rate was 50.5% for those who did not have an infectious disease physician consulting. They note that such consultation tends to improve more adequate treatment and prescribing for the complexities of fungal infections, especially in relations to the comorbidities or coinfections, like myocarditis. Moreover, infectious disease physicians are more likely to push for the removal of invasive devices, like central line catheters.
Overall, this study should be seen as yet another reminder that infectious disease physicians should be involved in the care of patients with infections known to be challenging and prone to antimicrobial resistance. It is important to use the expert insight of infectious disease physicians to ensure patient safety and care.