Effect of polymerase chain reaction-based antifungal stewardship on candidemia management in small- and medium-sized hospitals

Candidemia has high mortality and requires early antifungal stewardship (AFS). Management by non-infectious disease specialists has been associated with worse outcomes, particularly in small- and medium-sized hospitals where infectious disease expertise is often limited. Rapid diagnostic tools such as polymerase chain reaction (PCR) may facilitate earlier stewardship support; however, their clinical impact in these settings remains unclear. This study aimed to evaluate the effect of PCR-based AFS on candidemia management in small- and medium-sized hospitals.

We compared clinical data before and after the implementation of a PCR-based assay in patients aged ≥ 18 years with Candida species detected in blood cultures at Sapporo Tokushukai Hospital between June 2018 and May 2024 (n = 71 after exclusion). The primary endpoint was 30-day mortality rate. We also assessed the following secondary endpoints: rate of appropriate initial antifungal therapy, removal of central venous catheters (CVCs) within 24 h of diagnosis, prolonged antifungal therapy for ≥ 14 d after blood culture clearance, and time to antifungal therapy initiation.

No significant difference in 30-day mortality rate was observed between the pre-PCR and post-PCR groups (36.1% vs. 34.3%). Similarly, no significant differences were observed in rate of appropriate initial antifungal therapy, removal of CVCs within 24 h of diagnosis, prolonged antifungal therapy for ≥ 14 d after blood culture clearance, or time to therapy initiation. However, the proportion of physicians less familiar with candidemia care was significantly higher in the post-PCR group than in the pre-PCR group (68.6% vs. 36.1%, P = 0.01).

PCR-based AFS might have allowed the quality of candidemia management and patient outcomes to be maintained, even in small- and medium-sized hospitals with a high proportion of physicians less familiar with candidemia care.