Infectious-Disease Consult Linked to Fewer Candidemia Deaths

By Reuters Staff

October 05, 2019

NEW YORK (Reuters Health) - Patients with candida bloodstream infection who receive an infectious-disease consultation have lower mortality than those who don't get a consult, according to new findings.

"The protective effect of obtaining an infectious disease consultation on mortality in patients with candida bloodstream infection suggests that this consultation should be an integral part of the clinical care of patients with candidaemia," Dr. Carlos Mejia-Chew and colleagues of Washington University School of Medicine in St. Louis, Missouri, conclude in The Lancet Infectious Diseases, online September 24.

Candida is the second leading cause of bloodstream infection associated with health care, with a mortality rate of up to 47%, the authors note.

Infectious-disease consultation is linked to better-quality care and outcomes for patients with cryptococcal infection, invasive candidiasis and other infectious diseases, they add. Previous small studies suggest such consultation also reduces mortality in candida bloodstream infection.

Dr. Mejia-Chew and colleagues looked at medical charts for 1,691 patients with candida bloodstream infection treated at a single hospital, 45.9% of whom received an infectious-disease consultation.

Ninety-day mortality was 29% for patients who received the consultations and 51% for those who did not. Using propensity score weighting, the hazard ratio for infectious disease consultation was 0.81 (P<0.0001).

Median duration of antifungal treatment was 18 days for the consultation group and 14 days for the non-consult group. The consultation group were also more likely to have central-line removal, echocardiography and ophthalmological exams.

Only 2% of the consultation group went untreated, versus 14% of patients who did not receive consultation.

"The increased frequency of these interventions, not ignoring positive blood cultures and a longer duration of antifungal therapy, might have been responsible for the decreased mortality seen in the infectious disease consultation group," the authors state.

"We think that the high proportion of patients (14%) with a candida bloodstream infection who did not receive any antifungal treatment and did not have an infectious disease consultation is a particularly alarming finding," Dr. Katrien Lagrou and Dr. Eric Van Wijngaerden of KU Leuven in Belgium write in an accompanying editorial.

"We believe every hospital should have an expert management strategy addressing all individual cases of candidaemia," they add. "The need for such expert management should be incorporated in all future guidelines."


Lancet Infect Dis 2019.