Effect of the implementation of clinical guidelines on management of candidemia in elderly patients

• Published in: Mycoses Vol. 66; no. 9; pp. 810 - 814
• Main Authors: Lopez, Natalia Vicente, Parra, Jorge Calderon, Serrano, Alejandro Muñoz, Villanueva, Andrea Gutiérrez, Fuente Moral, Sara, Moreno‐Torres, Victor, Rubio, Elena Muñez, Martínez, Antonio Ramos
• Format: Journal Article
• Language: English
• Published: Germany Wiley Subscription Services, Inc 01-09-2023
• Subjects: Aged; Antifungal Agents - pharmacology; Antifungal Agents - therapeutic use; Candida; candidaemia; Candidemia; Candidemia - diagnosis; Candidemia - drug therapy; Candidemia - epidemiology; Central Venous Catheters; Clinical medicine; Clinical practice guidelines; Communicable Diseases - drug therapy; Echocardiography; Humans; Infectious diseases; Mortality; Patients; Retrospective Studies; Training; candidaemia; candidemia; Candida
• DOI: 10.1111/myc.13621
• EISSN: 1439-0507
• ISSN: 0933-7407

Introduction
Mortality from candidemia is higher in elderly population than in younger patients, which may be related to suboptimal management. The aim of the present study is to evaluate adherence to the recommendations for the clinical management of candidemia in a population over 75 years before and after implementing specific training.
Patients and Methods
We recorded retrospectively data from candidemia episodes in elderly patients during two periods of time: 2010–2015 years (before training) and 2017–2022 years (after training), as well as adherence to the recommendations of the clinical practice guidelines, mortality and consultation to infectious disease specialists.
Results
Forty‐five episodes of candidemia were recorded in the first period and 29 episodes in the second period. A better compliance to the recommendations of the clinical practice guidelines was observed in the second period: echocardiogram performance (75.9% vs. 48.9% p = .021), fundoscopy (65.5% vs. 44.4% p = .076), follow‐up blood cultures (72.4% vs. 42.2% p = .011), removal of central venous catheter (80% vs. 52.9% p = .080) and adequate antifungal treatment (82.6% vs. 52.6% p = .018). A trend towards lower mortality was observed during the second period (27.6% vs. 44.4% p = .144).
Conclusion
The improvement of knowledge of clinical guidelines on candidemia and the participation of infectious disease specialists may increase the quality of care in elderly patients with candidemia. It would be necessary to enlarge the sample size to evaluate the real impact of this intervention on mortality.