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Moni M, Sidharthan N, Sudhir S, Prabhu B, Nampoothiri V, James J, Philip JM, Thomas J, Antony R, Mohamed ZU, Kumar A, Prasanna P, Edathadathil F, Singh S, Sathyapalan D. A quality improvement initiative to improve the appropriateness of candidemia management by the implementation of a comprehensive candidemia care bundle at a tertiary care hospital in South India: Results of a quasi-experimental study. Medicine (Baltimore) 2022; 101:e28906. [PMID: 35421057 PMCID: PMC9276434 DOI: 10.1097/md.0000000000028906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 02/03/2022] [Indexed: 01/04/2023] Open
Abstract
Management of candidemia in developing countries like India encounters laxity in appropriate clinical management and challenges in terms of healthcare capacity, despite its association with high morbidity and mortality. Our study aims to evaluate the impact of a comprehensive candidemia care bundle implementation on appropriateness of therapy and major clinical outcomes.The single-center, quasi-experimental study conducted at a south Indian tertiary care center included adult patients diagnosed with candidemia. Following a retrospective review of candidemia patients of the pre-implementation period (January 2013-December 2015), the hospital antifungal stewardship team instituted a clinical pharmacist driven comprehensive candidemia care bundle for candidemia patients during the post-implementation period (October 2017-2019) and its impact on appropriateness of antifungal prescriptions and inpatient mortality was evaluated.The study included 175 patients with candidemia, comprising of 103 patients in the pre-implementation period and 72 patients in the post-implementation period. Appropriateness of antifungal prescriptions rose to 65% during post-implementation period from 30% observed in pre-implementation phase (P = .0005). The inhospital mortality rate reduced from 40% in the pre-implementation phase to 36% in the post-implementation phase, recording a 10% reduction over 2 years post-implementation (P = .26). No significant difference was observed in terms length of stay (P = .17).Our study demonstrates the successful implementation of an antifungal stewardship led comprehensive care bundle in a low middle income countries setting. The results of our study will have profound implications in improving the appropriateness of management of candidemia and feasibility of scaling up to wider settings could be explored.
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Affiliation(s)
- Merlin Moni
- Department of General Medicine and Division of Infectious Diseases, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Neeraj Sidharthan
- Department of Hematology, Blood and Marrow Transplantation, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Sangita Sudhir
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Binny Prabhu
- Department of Geriatrics and General Medicine, Epsom and St Heliers NHS trust, UK
| | - Vrinda Nampoothiri
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Jini James
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Jeslyn Mary Philip
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Jisha Thomas
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Remya Antony
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Zubair Umer Mohamed
- Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Anil Kumar
- Department of Microbiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Preetha Prasanna
- Department of General Medicine and Division of Infectious Diseases, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Fabia Edathadathil
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Sanjeev Singh
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Dipu Sathyapalan
- Department of General Medicine and Division of Infectious Diseases, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Fuchs BB, Eatemadpour S, Martel-Foley JM, Stott S, Toner M, Mylonakis E. Rapid Isolation and Concentration of Pathogenic Fungi Using Inertial Focusing on a Chip-Based Platform. Front Cell Infect Microbiol 2019; 9:27. [PMID: 30809512 PMCID: PMC6379272 DOI: 10.3389/fcimb.2019.00027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/25/2019] [Indexed: 11/13/2022] Open
Abstract
Systemic Candida infections remain a leading cause of nosocomial infections in the United States and worldwide. Many challenges remain in achieving rapid, direct diagnosis of fungal bloodstream infections due to limitations of conventional diagnostic methods that continue to demonstrate poor sensitivity, prolonged culture times that lead to delayed treatment, and detection variability between tests that compromises result reproducibility. Despite advancements in technology, mortality, and cost of care presented by blood stream infection with Candida spp. (candidemia) continues to rise and there is an urgent need for the development of novel methods to accurately detect Candida species present within the blood. This is especially true when patients are infected with drug resistant strains of Candida where accurate and immediate therapeutic treatment is of the importance. This study presents a method of separating fungal cells from lysed blood using inertial forces applied through microfluidics in order to abbreviate the time required to achieve a diagnosis by mitigating the need to grow blood cultures. We found that C. albicans can segregate into a focused stream distinct from white blood cells isolated within the Inertial Fungal Focuser (IFF) after red blood cell lysis. As a result of the focusing process, the collected cells are also concentrated 2.86 times. The same IFF device is applicable to non-albicans species: Candida parapsilosis, Candida glabrata, and Candida tropicalis, providing both isolation from lysed blood and a reduction in solution volume. Thus, the devised platform provides a means to isolate medically significant fungal cells from blood and concentrate the cells for further interrogation.
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Affiliation(s)
- Beth Burgwyn Fuchs
- Rhode Island Hospital, Alpert Medical School and Brown University, Providence, RI, United States
| | - Soraya Eatemadpour
- Rhode Island Hospital, Alpert Medical School and Brown University, Providence, RI, United States
| | - Joseph M. Martel-Foley
- BioMEMS Resource Center, Center for Engineering in Medicine and Surgical Services, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Shannon Stott
- BioMEMS Resource Center, Center for Engineering in Medicine and Surgical Services, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Mehmet Toner
- The Center for Engineering in Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Eleftherios Mylonakis
- Rhode Island Hospital, Alpert Medical School and Brown University, Providence, RI, United States
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Kaur H, Chakrabarti A. Strategies to Reduce Mortality in Adult and Neonatal Candidemia in Developing Countries. J Fungi (Basel) 2017; 3:E41. [PMID: 29371558 PMCID: PMC5715942 DOI: 10.3390/jof3030041] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 07/13/2017] [Accepted: 07/16/2017] [Indexed: 02/07/2023] Open
Abstract
Candidemia, the commonest invasive fungal infection, is associated with high morbidity and mortality in developing countries, though the exact prevalence is not known due to lack of systematic epidemiological data from those countries. The limited studies report a very high incidence of candidemia and unique epidemiology with a different spectrum of Candida species. The recent global emergence of multi-drug resistant Candida auris is looming large as an important threat in hospitalized patients of developing countries. While managing candidemia cases in those countries several challenges are faced, which include poor infrastructure; compromised healthcare and infection control practices; misuse and overuse of antibiotics and steroids; lack of awareness in fungal infections; non-availability of advance diagnostic tests and antifungal drugs in many areas; poor compliance to antifungal therapy and stewardship program. Considering the above limitations, innovative strategies are required to reduce mortality due to candidemia in adults and neonates. In the present review, we have unraveled the challenges of candidemia faced by low resource countries and propose a ten part strategy to reduce mortality due candidemia.
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Affiliation(s)
- Harsimran Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
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Arias S, Denis O, Montesinos I, Cherifi S, Miendje Deyi VY, Zech F. Epidemiology and mortality of candidemia both related and unrelated to the central venous catheter: a retrospective cohort study. Eur J Clin Microbiol Infect Dis 2016; 36:501-507. [PMID: 27832392 DOI: 10.1007/s10096-016-2825-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/17/2016] [Indexed: 11/25/2022]
Abstract
Our objective was to compare mortality, epidemiology, and morbidity in hospitalized patients with candidemia which was both related and unrelated to the central venous catheter (CVC). This was a monocentric, retrospective cohort study of candidemia. The sample consisted of 103 patients with laboratory-confirmed nosocomial candidemia hospitalized between 2006 and 2013 in a tertiary care public hospital. We included 65 (63.1 %) patients (24 in the CVC-positive group, 41 in the CVC-negative group). Demographic data and risk factors were recorded using a structured case report form. In the group of candidemia associated to the CVC, survival at day 50 was 58.6 ± 11.9 %, compared to 26.5 ± 8.9 % for the CVC-negative group (p-value = 0.012); the hazard ratio of death was 0.38 (95 % confidence interval 0.17-0.85, p-value = 0.019). Compared with the CVC-positive patients, CVC-negative patients were often colonized with yeast (41.5 % vs. 16.7 %, p-value = 0.041), had a shorter previous in-hospital stay (20 days vs. 34 days, p-value = 0.023), and were more severely ill (severe sepsis 85.4 % vs. 58.3 %, p-value = 0.016). In this study, when the origin of candidemia was not the CVC, patients were more seriously ill, had a higher mortality rate, and the removal of the catheter seemed to lead to disappointing results. It would be useful to explore the impact of retention of the CVC on survival in the CVC-negative patients, where the CVCs are essential to treating these patients.
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Affiliation(s)
- S Arias
- Public Health Department, Hôpital Brugmann, Infectious Diseases Department, Université Libre de Bruxelles, 4 place A Van Gehuchten, 1020, Brussels, Belgium.
| | - O Denis
- Hôpital Erasme, Microbiology Department, Université Libre de Bruxelles, 808 Route de Lennik, 1070, Brussels, Belgium
| | - I Montesinos
- Hôpital Erasme, Microbiology Department, Université Libre de Bruxelles, 808 Route de Lennik, 1070, Brussels, Belgium
| | - S Cherifi
- Internal Medicine Department, Centre Hospitalier Universitaire de Charleroi, Hôpital Civil Marie Curie, 140 Chaussée de Bruxelles, 6042, Lodelinsart, Belgium
| | - V Y Miendje Deyi
- Microbiology Department LHUB-ULB, Laboratoire Hospitalier Universitaire de Bruxelles (Brussels Academic Hospital Lab), Université Libre de Bruxelles, 322 rue Haute, 1000, Brussels, Belgium
| | - F Zech
- Infectious Diseases Department, Université Catholique de Louvain, 31 Promenade de l'Alma, 1200, Brussels, Belgium
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