QJM Advance Access published online on August 25, 2006
QJM, doi:10.1093/qjmed/hcl087
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1 From the Infectious Diseases Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK; From the Clinical Microbiology Laboratory, Health Protection Agency, Addenbrooke's Hospital, Cambridge, UK
* To whom correspondence should be addressed. Background: Candidaemias are associated with significant morbidity and mortality. The British Society of Medical Mycology and Infectious Diseases Society of America recently published audit standards, to address the changing epidemiology of candidaemia and to improve outcomes. Aim: To investigate the local epidemiology of candidaemia and the standard of care in a large teaching hospital. Design: Retrospective audit. Methods: Data were obtained for all candidaemia episodes over the 4-year period ending July 2004, from the medical and nursing notes, laboratory computer and patient administration system. Results: We identified 92 episodes in 90 patients. The main predisposing factors were being on an intensive care unit, having a central venous catheter, and (for neonates) prematurity. Central venous catheters were removed at a mean 1.8 days following candidaemia; 79% (37/47) were removed within 48 h (the audit standard). Identification and susceptibility tests were performed for 94.7% of isolates. All were susceptible to amphotericin B; 87% were susceptible to fluconazole. Antifungal treatment was started within 24 h of a positive blood culture in 84% of episodes. Initial antifungal therapy was appropriate in 95% (61/64) of treated cases. Most patients (81%) who survived or completed their intended course of treatment before death received at least 2 weeks treatment. However, only 45% of those transferred to other hospitals had accompanying guidance on the intended further duration of therapy. Thirty-day mortality was 41%. After adjustment for age, the presence of Candida-related complications was associated with an odds ratio for mortality of 6.5 (95% CI 1.2-36.5, p = 0.03). Discussion: Overall the audit standards set by the BSMM and IDSA were met, and discrepancies did not lead to a change in outcome. Improved intravenous catheter care, a more pro-active approach to searching for complications, and improvement in the inter-hospital transfer process, will assist in reducing morbidity and mortality.
Received March 16, 2006
Accepted May 20, 2006
Original Papers
Candidaemia in a large teaching hospital: a clinical audit
S.H. Aliyu 1 *, D.A. Enoch 2, I.I. Abubakar 3, R. Ali 4, A.J. Carmichael 4, M. Farrington 2, and A.M.L. Lever 4
2 From the Clinical Microbiology Laboratory, Health Protection Agency, Addenbrooke's Hospital, Cambridge, UK
3 From the School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
4 From the Infectious Diseases Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
S.H. Aliyu, E-mail: sani.aliyu{at}addenbrookes.nhs.uk
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