The Impact of Infectious Diseases Consultation on the Choice of Antifungal Therapy in Patients With Candidemia

Abstract

Background Candidemia is the fourth most common cause of nosocomial bloodstream infections in the United States. Delay in starting appropriate antifungal therapy in patients with candidemia has been associated with increased mortality rates. The goal of this study was to evaluate the impact of infectious diseases (ID) consultation on the class of antifungal therapy used and on all-cause 90-day mortality in patients with candidemia. Methods Candidemic subjects were retrospectively identified by reviewing our hospital's blood culture log books. Medical records of each subject were reviewed for class and length of antifungal agent used, length of hospitalization, evidence of an ID consultation, and 90-day mortality. Results One hundred sixty-three patients with 182 episodes of candidemia were identified during a 6-year period from January 1, 2008, to December 31, 2013. Infectious diseases consultation resulted in significantly greater use of azole therapy compared with no ID consult (67.7% vs 26.3%, P < 0.0001) and comparable durations of therapy (15.3 vs 12.3 days, P = 0.0885). Conclusions Infectious diseases consultation in patients with candidemia results in a significantly higher rate of fluconazole use and minimally longer durations of antifungal therapy, thereby helping to reduce pharmacy costs.