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Analyzing Adherence to the 2016 Infectious Diseases Society of America Guidelines for Candidemia in Cancer Patients
Dena M Lehmann1, Nina Cohen2, I-Hsin Lin3
1Syneos Health, New York, New York, USA.
Background:
Candidemia is associated with morbidity and mortality in cancer patients. We analyzed adherence to the 2016 Infectious Diseases Society of America (IDSA) candidiasis guidelines and the reasons for guideline nonadherence. We also investigated whether matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) improved time to effective antifungal therapy compared with historical data (median, 43.2 hours).
Methods:
Cancer patients with candidemia between 1/1/17 and 12/31/19 were included. Adherence to 7 individual IDSA guideline components was assessed. Composite IDSA guideline adherence (defined as meeting ≥6 guideline components) was also assessed. Charts were reviewed to examine reasons for noncompliance.
Results:
Of 157 patients with candidemia, 150 (95.5%) had infectious disease (ID) consultation. The median total time from blood culture collection to antifungal initiation was 42.1 hours. Excluding 39 patients with short treatment due to death, there was 100% adherence with surveillance blood cultures, followed by antifungal susceptibility testing (117/118, 99.2%), initial appropriate therapy (117/118, 99.2%), antifungal duration (110/118, 93.2%), line removal (82/91, 90.1%), eye exams (93/118, 78.8%), and step-down therapy (69/94, 73.4%). A quarter (30/118) did not meet composite IDSA guideline adherence. Univariate logistic regression suggested a relationship between poor cancer prognosis and incomplete adherence to the 2016 IDSA candidiasis guidelines (odds ratio, 8.6; 95% CI, 1.6-47).
Conclusions:
The addition of MALDI-TOF did not shorten time to effective antifungal therapy. Nearly all patients were seen by ID for candidemia. Poor cancer prognosis was a common factor for incomplete composite adherence to the 2016 IDSA candidiasis guidelines.
Insights
Adherence to 2016 Infectious Diseases Society of America (IDSA) candidiasis guidelines in cancer patients with candidemia was high, but composite adherence was lower. Poor cancer prognosis was linked to incomplete guideline adherence.
Area of Science:
- Infectious Diseases
- Oncology
- Clinical Microbiology
Background:
- Candidemia poses significant morbidity and mortality risks in cancer patients.
- Evaluating adherence to clinical guidelines is crucial for optimizing patient outcomes.
- The impact of advanced diagnostic techniques like MALDI-TOF on treatment timelines requires investigation.
Purpose of the Study:
- To assess adherence to the 2016 Infectious Diseases Society of America (IDSA) candidiasis guidelines in cancer patients.
- To identify reasons for nonadherence to these guidelines.
- To determine if matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) impacts time to effective antifungal therapy.
Main Methods:
- Retrospective analysis of cancer patients diagnosed with candidemia between January 1, 2017, and December 31, 2019.
- Assessment of adherence to seven individual components of the 2016 IDSA candidiasis guidelines.
- Review of patient charts to identify reasons for guideline noncompliance.
Main Results:
- Of 157 patients, 150 (95.5%) received infectious disease consultation.
- Median time to antifungal initiation was 42.1 hours; MALDI-TOF did not shorten this duration.
- Composite adherence to IDSA guidelines was achieved by 75% of patients, with poor cancer prognosis associated with nonadherence.
Conclusions:
- While individual guideline components showed high adherence, overall composite adherence was suboptimal.
- Infectious disease consultation was nearly universal for candidemia cases.
- Poor cancer prognosis emerged as a significant factor associated with incomplete adherence to candidiasis guidelines.
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