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Impact of automatic infectious diseases consultation on the management of fungemia at a large academic medical center.

Publication ,  Journal Article
Jones, TM; Drew, RH; Wilson, DT; Sarubbi, C; Anderson, DJ
Published in: Am J Health Syst Pharm
December 1, 2017

PURPOSE: The impact of automatic infectious diseases (ID) consultation for inpatients with fungemia at a large academic medical center was studied. METHODS: In this single-center, retrospective study, the time to appropriate antifungal therapy before and after implementing a policy requiring automatic ID consultation for the management of fungemia for all patients with an inpatient positive blood culture for fungus was examined. The rates of ID consultation; the likelihood of receiving appropriate antifungal therapy; central venous catheter (CVC) removal rates; performance of ophthalmologic examinations; infection-related length of stay (LOS); rates of all-cause inhospital mortality, death, or transfer to an intensive care unit within 7 days of first culture; and inpatient cost of antifungals were also evaluated. RESULTS: A total of 173 unique episodes (94 and 79 in the control and intervention groups, respectively) were included. Candida species were the most frequently cultured organisms, isolated from over 90% of patients in both groups. No differences were observed between the control and intervention groups in time to appropriate therapy, infection-related LOS, or time to CVC removal. However, patients in the intervention group were more likely than those in the control group to receive appropriate antifungal therapy (p = 0.0392), undergo ophthalmologic examination (p = 0.003), have their CVC removed (p = 0.0038), and receive ID consultation (p = 0.0123). Inpatient antifungal costs were significantly higher in the intervention group (p = 0.0177). CONCLUSION: While automatic ID consultation for inpatients with fungemia did not affect the time to administration of appropriate therapy, improvement was observed for several process indicators, including rates of appropriate antifungal therapy selection, time to removal of CVCs, and performance of ophthalmologic examinations.

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Published In

Am J Health Syst Pharm

DOI

EISSN

1535-2900

Publication Date

December 1, 2017

Volume

74

Issue

23

Start / End Page

1997 / 2003

Location

England

Related Subject Headings

  • Retrospective Studies
  • Referral and Consultation
  • Pharmacology & Pharmacy
  • Middle Aged
  • Male
  • Length of Stay
  • Humans
  • Fungemia
  • Female
  • Eye Diseases
 

Citation

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Jones, T. M., Drew, R. H., Wilson, D. T., Sarubbi, C., & Anderson, D. J. (2017). Impact of automatic infectious diseases consultation on the management of fungemia at a large academic medical center. Am J Health Syst Pharm, 74(23), 1997–2003. https://doi.org/10.2146/ajhp170113
Jones, Travis M., Richard H. Drew, Dustin T. Wilson, Christina Sarubbi, and Deverick J. Anderson. “Impact of automatic infectious diseases consultation on the management of fungemia at a large academic medical center.Am J Health Syst Pharm 74, no. 23 (December 1, 2017): 1997–2003. https://doi.org/10.2146/ajhp170113.
Jones TM, Drew RH, Wilson DT, Sarubbi C, Anderson DJ. Impact of automatic infectious diseases consultation on the management of fungemia at a large academic medical center. Am J Health Syst Pharm. 2017 Dec 1;74(23):1997–2003.
Jones, Travis M., et al. “Impact of automatic infectious diseases consultation on the management of fungemia at a large academic medical center.Am J Health Syst Pharm, vol. 74, no. 23, Dec. 2017, pp. 1997–2003. Pubmed, doi:10.2146/ajhp170113.
Jones TM, Drew RH, Wilson DT, Sarubbi C, Anderson DJ. Impact of automatic infectious diseases consultation on the management of fungemia at a large academic medical center. Am J Health Syst Pharm. 2017 Dec 1;74(23):1997–2003.
Journal cover image

Published In

Am J Health Syst Pharm

DOI

EISSN

1535-2900

Publication Date

December 1, 2017

Volume

74

Issue

23

Start / End Page

1997 / 2003

Location

England

Related Subject Headings

  • Retrospective Studies
  • Referral and Consultation
  • Pharmacology & Pharmacy
  • Middle Aged
  • Male
  • Length of Stay
  • Humans
  • Fungemia
  • Female
  • Eye Diseases