Celia Cardozo1, Guillermo Cuervo2, Miguel Salavert3, Paloma Merino4, Francesca Gioia5, Mario Fernández-Ruiz6, Luis E López-Cortés7, Laura Escolá-Vergé8, Miguel Montejo9, Patricia Muñoz10, Manuela Aguilar-Guisado11, Pedro Puerta-Alcalde1, Mariona Tasias3, Alba Ruiz-Gaitán3, Fernando González4, Mireia Puig-Asensio8, Antonio Vena10, Francesc Marco1, Javier Pemán3, Jesús Fortún5, José María Aguado6, Benito Almirante8, Alejandro Soriano1, Jordi Carratalá2, Carolina Garcia-Vidal1. 1. Hospital Clínic, IDIBAPS (Institut d'Investigacions biomèdiques Agust Pi i Sunyer), Universitat de Barcelona, Barcelona, Spain. 2. Hospital Universitari de Bellvitge, IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain. 3. Hospital Universitari I Politecnic 'La Fe', Valencia, Spain. 4. Hospital Universitario Clínico 'San Carlos', Madrid, Spain. 5. Hospital Universitario 'Ramón y Cajal', Madrid, Spain. 6. Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (i+12), Universidad Complutense de Madrid, Madrid, Spain. 7. Unidad Clínica de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena/Instituto de Biomedicina de Sevilla (IBiS)/Universidad de Sevilla/Centro Superior de Investigaciones Científicas, Sevilla, Spain. 8. Hospital Universitari Vall d'Hebron, VHIR (Vall d'Hebron Institut de Recerca), Universitat Autònoma de Barcelona, Barcelona, Spain. 9. Hospital Universitario 'Cruces', Bilbao, Spain. 10. Hospital General Universitario Gregorio Marañón e Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain. 11. Hospital Universitario 'Virgen del Rocío', Sevilla, Spain.
Abstract
BACKGROUND: Candidaemia is a leading cause of bloodstream infections in hospitalized patients all over the world. It remains associated with high mortality. OBJECTIVES: To assess the impact of implementing an evidence-based package of measures (bundle) on the quality of care and outcomes of candidaemia. METHODS: A systematic review of the literature was performed to identify measures related to better outcomes in candidaemia. Eight quality-of-care indicators (QCIs) were identified and a set of written recommendations (early treatment, echinocandins in septic shock, source control, follow-up blood culture, ophthalmoscopy, echocardiography, de-escalation, length of treatment) was prospectively implemented. The study was performed in 11 tertiary hospitals in Spain. A quasi-experimental design before and during bundle implementation (September 2016 to February 2018) was used. For the pre-intervention period, data from the prospective national surveillance were used (May 2010 to April 2011). RESULTS: A total of 385 and 263 episodes were included in the pre-intervention and intervention groups, respectively. Adherence to all QCIs improved in the intervention group. The intervention group had a decrease in early (OR 0.46; 95% CI 0.23-0.89; P = 0.022) and overall (OR 0.61; 95% CI 0.4-0.94; P = 0.023) mortality after controlling for potential confounders. CONCLUSIONS: Implementing a structured, evidence-based intervention bundle significantly improved patient care and early and overall mortality in patients with candidaemia. Institutions should embrace this objective strategy and use the bundle as a means to measure high-quality medical care of patients.
BACKGROUND: Candidaemia is a leading cause of bloodstream infections in hospitalized patients all over the world. It remains associated with high mortality. OBJECTIVES: To assess the impact of implementing an evidence-based package of measures (bundle) on the quality of care and outcomes of candidaemia. METHODS: A systematic review of the literature was performed to identify measures related to better outcomes in candidaemia. Eight quality-of-care indicators (QCIs) were identified and a set of written recommendations (early treatment, echinocandins in septic shock, source control, follow-up blood culture, ophthalmoscopy, echocardiography, de-escalation, length of treatment) was prospectively implemented. The study was performed in 11 tertiary hospitals in Spain. A quasi-experimental design before and during bundle implementation (September 2016 to February 2018) was used. For the pre-intervention period, data from the prospective national surveillance were used (May 2010 to April 2011). RESULTS: A total of 385 and 263 episodes were included in the pre-intervention and intervention groups, respectively. Adherence to all QCIs improved in the intervention group. The intervention group had a decrease in early (OR 0.46; 95% CI 0.23-0.89; P = 0.022) and overall (OR 0.61; 95% CI 0.4-0.94; P = 0.023) mortality after controlling for potential confounders. CONCLUSIONS: Implementing a structured, evidence-based intervention bundle significantly improved patient care and early and overall mortality in patients with candidaemia. Institutions should embrace this objective strategy and use the bundle as a means to measure high-quality medical care of patients.
Authors: Melissa D Johnson; Russell E Lewis; Elizabeth S Dodds Ashley; John R Perfect; Dimitrios P Kontoyiannis Journal: J Infect Dis Date: 2021-11-16 Impact factor: 5.226