Impact of automatic infectious diseases consultation on the management of fungemia at a large academic medical center
| Autor: | Richard H. Drew, Travis M Jones, Deverick J. Anderson, Christina Sarubbi, Dustin Wilson |
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| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
Antifungal Adult Male medicine.medical_specialty Pediatrics Antifungal Agents Eye Diseases medicine.drug_class medicine.medical_treatment 030106 microbiology Communicable Diseases law.invention 03 medical and health sciences Automation law Intervention (counseling) medicine Central Venous Catheters Humans Referral and Consultation Fungemia Aged Candida Retrospective Studies Pharmacology Academic Medical Centers business.industry Health Policy Inpatient cost Disease Management Retrospective cohort study Length of Stay Middle Aged medicine.disease Intensive care unit Infectious diseases consultation Catheter-Related Infections Emergency medicine Female business Central venous catheter |
| Zdroj: | American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists. 74(23) |
| ISSN: | 1535-2900 |
| Popis: | Purpose The impact of automatic infectious diseases (ID) consultation for inpatients with fungemia at a large academic medical center was studied. Methods In this single-center, retrospective study, the time to appropriate antifungal therapy before and after implementing a policy requiring automatic ID consultation for the management of fungemia for all patients with an inpatient positive blood culture for fungus was examined. The rates of ID consultation; the likelihood of receiving appropriate antifungal therapy; central venous catheter (CVC) removal rates; performance of ophthalmologic examinations; infection-related length of stay (LOS); rates of all-cause inhospital mortality, death, or transfer to an intensive care unit within 7 days of first culture; and inpatient cost of antifungals were also evaluated. Results A total of 173 unique episodes (94 and 79 in the control and intervention groups, respectively) were included. Candida species were the most frequently cultured organisms, isolated from over 90% of patients in both groups. No differences were observed between the control and intervention groups in time to appropriate therapy, infection-related LOS, or time to CVC removal. However, patients in the intervention group were more likely than those in the control group to receive appropriate antifungal therapy ( p = 0.0392), undergo ophthalmologic examination ( p = 0.003), have their CVC removed ( p = 0.0038), and receive ID consultation ( p = 0.0123). Inpatient antifungal costs were significantly higher in the intervention group ( p = 0.0177). Conclusion While automatic ID consultation for inpatients with fungemia did not affect the time to administration of appropriate therapy, improvement was observed for several process indicators, including rates of appropriate antifungal therapy selection, time to removal of CVCs, and performance of ophthalmologic examinations. |
| Databáze: | OpenAIRE |
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