Improving the management of candidemia through antimicrobial stewardship interventions.

ABSTRACT

Candidemia is associated with significant morbidity, mortality, and hospital cost. We conducted a quasi-experimental study to evaluate the impact of an Antimicrobial Stewardship Program (ASP) pharmacist's interventions on time to effective antifungal therapy, in-hospital mortality, infection-related length of stay (LOS), and costs in patients with candidemia. Patients in 2008 (pre-intervention, n = 85) were compared to those in 2010 (post-intervention, n = 88). Time to effective therapy was significantly faster (median 13.5 versus 1.3 hours, P = 0.04) and was administered to more patients in the post-intervention group [67 (88%) versus 80 (99%), P = 0.008]. There was no significant difference in in-hospital mortality [16 (19%) versus 26 (30%) patients, P = 0.11], infection-related LOS [10 (7-15.5) versus 11 (7-17) days, P = 0.68], or hospital costs during candidemia [$25,697 (15,645-42,870) versus $31,457 ($16,399-83,649), P = 0.25]. ASP pharmacist interventions standardized and improved the quality of care of patients with candidemia.