Management bundles for candidaemia: The impact of compliance on clinical outcomes

Yoshio Takesue, Takashi Ueda, Hiroshige Mikamo, Shigeto Oda, Shunji Takakura, Yuukou Kitagawa, Shigeru Kohno, A. Masuda, C. Yoshida, C. Yasunaga, C. Yamashita, E. Nakataki, H. Ohyagi, H. Yagi, H. Johnai, H. Murai, H. Hanamoto, I. Nakamura, I. Sanada, I. TandaiJ. Kuroki, J. Ogawa, K. Kawahara, K. Amino, K. Nakajima, K. Yoshimoto, K. Takeda, K. Nakamura, K. Suzuki, K. Yamada, M. Aizawa, M. Hashimoto, M. Ogata, M. Shirano, M. Kawada, M. Kaneda, M. Yoshioka, N. Okuda, N. Sugita, N. Kikuchi, S. Fuke, S. Tsuchihashi, S. Sugitani, S. Ikuta, S. Honda, T. Nei, T. Iwamura, T. Yagi, T. Kaji, Y. Ichimiya, Y. Kobayashi, Y. Minamishima, Y. Goto, Y. Hatano, Y. Nagao, Y. Yamagishi, J. Sashihara, A. Tsukamoto, T. Kawaoka, M. Kobayashi

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objectives: The Mycoses Forum in Japan has developed management bundles for candidaemia to incorporate into bedside practice. The aim of this study was to investigate nationwide compliance with the bundles and their impact on clinical outcomes. Methods: Non-neutropenic patients treated with antifungals for candidaemia were surveyed. Bundles consist of nine items to complete. Data were sent to the central office between July 2011 and April 2012. Results: Six hundred and eight patients were analysed. The compliance rate for achieving all elements was 6.9%, and it increased to 21.4% when compliance was analysed by the bundle except for oral switch. There was a significant difference in clinical success between patients with and without compliance [92.9% versus 75.8% (P=0.011)]. Compliance with the bundles, however, failed to be an independent factor associated with favourable outcomes. When step-down oral therapy was excluded from the elements of compliance, compliance with the bundles was revealed to be an independent predictor of clinical success (OR 4.42, 95% CI 2.05-9.52) and mortality (OR 0.27, 95% CI 0.13-0.57). Independent individual elements contributing to clinical success were removal of central venous catheters within 24 h, assessment of clinical efficacy on the third to the fifth day and at least 2 weeks of therapy after clearance of candidaemia. Conclusions: Compliance with the bundles for candidaemia had a beneficial effect on clinical outcomes. Promotion of the bundles approach may have the potential to narrow the gap between clinical evidence and bedside practice.

Original languageEnglish
Pages (from-to)587-593
Number of pages7
JournalJournal of Antimicrobial Chemotherapy
Volume70
Issue number2
DOIs
Publication statusPublished - 2015 Feb 1
Externally publishedYes

Fingerprint

Candidemia
Compliance
Central Venous Catheters
Mycoses
Japan
Mortality
Therapeutics

Keywords

  • Candidiasis
  • Fungal infections
  • Guidelines
  • Intravenous catheters
  • Invasive disease

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Management bundles for candidaemia : The impact of compliance on clinical outcomes. / Takesue, Yoshio; Ueda, Takashi; Mikamo, Hiroshige; Oda, Shigeto; Takakura, Shunji; Kitagawa, Yuukou; Kohno, Shigeru; Masuda, A.; Yoshida, C.; Yasunaga, C.; Yamashita, C.; Nakataki, E.; Ohyagi, H.; Yagi, H.; Johnai, H.; Murai, H.; Hanamoto, H.; Nakamura, I.; Sanada, I.; Tandai, I.; Kuroki, J.; Ogawa, J.; Kawahara, K.; Amino, K.; Nakajima, K.; Yoshimoto, K.; Takeda, K.; Nakamura, K.; Suzuki, K.; Yamada, K.; Aizawa, M.; Hashimoto, M.; Ogata, M.; Shirano, M.; Kawada, M.; Kaneda, M.; Yoshioka, M.; Okuda, N.; Sugita, N.; Kikuchi, N.; Fuke, S.; Tsuchihashi, S.; Sugitani, S.; Ikuta, S.; Honda, S.; Nei, T.; Iwamura, T.; Yagi, T.; Kaji, T.; Ichimiya, Y.; Kobayashi, Y.; Minamishima, Y.; Goto, Y.; Hatano, Y.; Nagao, Y.; Yamagishi, Y.; Sashihara, J.; Tsukamoto, A.; Kawaoka, T.; Kobayashi, M.

In: Journal of Antimicrobial Chemotherapy, Vol. 70, No. 2, 01.02.2015, p. 587-593.

Research output: Contribution to journalArticle

Takesue, Y, Ueda, T, Mikamo, H, Oda, S, Takakura, S, Kitagawa, Y, Kohno, S, Masuda, A, Yoshida, C, Yasunaga, C, Yamashita, C, Nakataki, E, Ohyagi, H, Yagi, H, Johnai, H, Murai, H, Hanamoto, H, Nakamura, I, Sanada, I, Tandai, I, Kuroki, J, Ogawa, J, Kawahara, K, Amino, K, Nakajima, K, Yoshimoto, K, Takeda, K, Nakamura, K, Suzuki, K, Yamada, K, Aizawa, M, Hashimoto, M, Ogata, M, Shirano, M, Kawada, M, Kaneda, M, Yoshioka, M, Okuda, N, Sugita, N, Kikuchi, N, Fuke, S, Tsuchihashi, S, Sugitani, S, Ikuta, S, Honda, S, Nei, T, Iwamura, T, Yagi, T, Kaji, T, Ichimiya, Y, Kobayashi, Y, Minamishima, Y, Goto, Y, Hatano, Y, Nagao, Y, Yamagishi, Y, Sashihara, J, Tsukamoto, A, Kawaoka, T & Kobayashi, M 2015, 'Management bundles for candidaemia: The impact of compliance on clinical outcomes', Journal of Antimicrobial Chemotherapy, vol. 70, no. 2, pp. 587-593. https://doi.org/10.1093/jac/dku414
Takesue, Yoshio ; Ueda, Takashi ; Mikamo, Hiroshige ; Oda, Shigeto ; Takakura, Shunji ; Kitagawa, Yuukou ; Kohno, Shigeru ; Masuda, A. ; Yoshida, C. ; Yasunaga, C. ; Yamashita, C. ; Nakataki, E. ; Ohyagi, H. ; Yagi, H. ; Johnai, H. ; Murai, H. ; Hanamoto, H. ; Nakamura, I. ; Sanada, I. ; Tandai, I. ; Kuroki, J. ; Ogawa, J. ; Kawahara, K. ; Amino, K. ; Nakajima, K. ; Yoshimoto, K. ; Takeda, K. ; Nakamura, K. ; Suzuki, K. ; Yamada, K. ; Aizawa, M. ; Hashimoto, M. ; Ogata, M. ; Shirano, M. ; Kawada, M. ; Kaneda, M. ; Yoshioka, M. ; Okuda, N. ; Sugita, N. ; Kikuchi, N. ; Fuke, S. ; Tsuchihashi, S. ; Sugitani, S. ; Ikuta, S. ; Honda, S. ; Nei, T. ; Iwamura, T. ; Yagi, T. ; Kaji, T. ; Ichimiya, Y. ; Kobayashi, Y. ; Minamishima, Y. ; Goto, Y. ; Hatano, Y. ; Nagao, Y. ; Yamagishi, Y. ; Sashihara, J. ; Tsukamoto, A. ; Kawaoka, T. ; Kobayashi, M. / Management bundles for candidaemia : The impact of compliance on clinical outcomes. In: Journal of Antimicrobial Chemotherapy. 2015 ; Vol. 70, No. 2. pp. 587-593.
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abstract = "Objectives: The Mycoses Forum in Japan has developed management bundles for candidaemia to incorporate into bedside practice. The aim of this study was to investigate nationwide compliance with the bundles and their impact on clinical outcomes. Methods: Non-neutropenic patients treated with antifungals for candidaemia were surveyed. Bundles consist of nine items to complete. Data were sent to the central office between July 2011 and April 2012. Results: Six hundred and eight patients were analysed. The compliance rate for achieving all elements was 6.9{\%}, and it increased to 21.4{\%} when compliance was analysed by the bundle except for oral switch. There was a significant difference in clinical success between patients with and without compliance [92.9{\%} versus 75.8{\%} (P=0.011)]. Compliance with the bundles, however, failed to be an independent factor associated with favourable outcomes. When step-down oral therapy was excluded from the elements of compliance, compliance with the bundles was revealed to be an independent predictor of clinical success (OR 4.42, 95{\%} CI 2.05-9.52) and mortality (OR 0.27, 95{\%} CI 0.13-0.57). Independent individual elements contributing to clinical success were removal of central venous catheters within 24 h, assessment of clinical efficacy on the third to the fifth day and at least 2 weeks of therapy after clearance of candidaemia. Conclusions: Compliance with the bundles for candidaemia had a beneficial effect on clinical outcomes. Promotion of the bundles approach may have the potential to narrow the gap between clinical evidence and bedside practice.",
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author = "Yoshio Takesue and Takashi Ueda and Hiroshige Mikamo and Shigeto Oda and Shunji Takakura and Yuukou Kitagawa and Shigeru Kohno and A. Masuda and C. Yoshida and C. Yasunaga and C. Yamashita and E. Nakataki and H. Ohyagi and H. Yagi and H. Johnai and H. Murai and H. Hanamoto and I. Nakamura and I. Sanada and I. Tandai and J. Kuroki and J. Ogawa and K. Kawahara and K. Amino and K. Nakajima and K. Yoshimoto and K. Takeda and K. Nakamura and K. Suzuki and K. Yamada and M. Aizawa and M. Hashimoto and M. Ogata and M. Shirano and M. Kawada and M. Kaneda and M. Yoshioka and N. Okuda and N. Sugita and N. Kikuchi and S. Fuke and S. Tsuchihashi and S. Sugitani and S. Ikuta and S. Honda and T. Nei and T. Iwamura and T. Yagi and T. Kaji and Y. Ichimiya and Y. Kobayashi and Y. Minamishima and Y. Goto and Y. Hatano and Y. Nagao and Y. Yamagishi and J. Sashihara and A. Tsukamoto and T. Kawaoka and M. Kobayashi",
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TY - JOUR

T1 - Management bundles for candidaemia

T2 - The impact of compliance on clinical outcomes

AU - Takesue, Yoshio

AU - Ueda, Takashi

AU - Mikamo, Hiroshige

AU - Oda, Shigeto

AU - Takakura, Shunji

AU - Kitagawa, Yuukou

AU - Kohno, Shigeru

AU - Masuda, A.

AU - Yoshida, C.

AU - Yasunaga, C.

AU - Yamashita, C.

AU - Nakataki, E.

AU - Ohyagi, H.

AU - Yagi, H.

AU - Johnai, H.

AU - Murai, H.

AU - Hanamoto, H.

AU - Nakamura, I.

AU - Sanada, I.

AU - Tandai, I.

AU - Kuroki, J.

AU - Ogawa, J.

AU - Kawahara, K.

AU - Amino, K.

AU - Nakajima, K.

AU - Yoshimoto, K.

AU - Takeda, K.

AU - Nakamura, K.

AU - Suzuki, K.

AU - Yamada, K.

AU - Aizawa, M.

AU - Hashimoto, M.

AU - Ogata, M.

AU - Shirano, M.

AU - Kawada, M.

AU - Kaneda, M.

AU - Yoshioka, M.

AU - Okuda, N.

AU - Sugita, N.

AU - Kikuchi, N.

AU - Fuke, S.

AU - Tsuchihashi, S.

AU - Sugitani, S.

AU - Ikuta, S.

AU - Honda, S.

AU - Nei, T.

AU - Iwamura, T.

AU - Yagi, T.

AU - Kaji, T.

AU - Ichimiya, Y.

AU - Kobayashi, Y.

AU - Minamishima, Y.

AU - Goto, Y.

AU - Hatano, Y.

AU - Nagao, Y.

AU - Yamagishi, Y.

AU - Sashihara, J.

AU - Tsukamoto, A.

AU - Kawaoka, T.

AU - Kobayashi, M.

PY - 2015/2/1

Y1 - 2015/2/1

N2 - Objectives: The Mycoses Forum in Japan has developed management bundles for candidaemia to incorporate into bedside practice. The aim of this study was to investigate nationwide compliance with the bundles and their impact on clinical outcomes. Methods: Non-neutropenic patients treated with antifungals for candidaemia were surveyed. Bundles consist of nine items to complete. Data were sent to the central office between July 2011 and April 2012. Results: Six hundred and eight patients were analysed. The compliance rate for achieving all elements was 6.9%, and it increased to 21.4% when compliance was analysed by the bundle except for oral switch. There was a significant difference in clinical success between patients with and without compliance [92.9% versus 75.8% (P=0.011)]. Compliance with the bundles, however, failed to be an independent factor associated with favourable outcomes. When step-down oral therapy was excluded from the elements of compliance, compliance with the bundles was revealed to be an independent predictor of clinical success (OR 4.42, 95% CI 2.05-9.52) and mortality (OR 0.27, 95% CI 0.13-0.57). Independent individual elements contributing to clinical success were removal of central venous catheters within 24 h, assessment of clinical efficacy on the third to the fifth day and at least 2 weeks of therapy after clearance of candidaemia. Conclusions: Compliance with the bundles for candidaemia had a beneficial effect on clinical outcomes. Promotion of the bundles approach may have the potential to narrow the gap between clinical evidence and bedside practice.

AB - Objectives: The Mycoses Forum in Japan has developed management bundles for candidaemia to incorporate into bedside practice. The aim of this study was to investigate nationwide compliance with the bundles and their impact on clinical outcomes. Methods: Non-neutropenic patients treated with antifungals for candidaemia were surveyed. Bundles consist of nine items to complete. Data were sent to the central office between July 2011 and April 2012. Results: Six hundred and eight patients were analysed. The compliance rate for achieving all elements was 6.9%, and it increased to 21.4% when compliance was analysed by the bundle except for oral switch. There was a significant difference in clinical success between patients with and without compliance [92.9% versus 75.8% (P=0.011)]. Compliance with the bundles, however, failed to be an independent factor associated with favourable outcomes. When step-down oral therapy was excluded from the elements of compliance, compliance with the bundles was revealed to be an independent predictor of clinical success (OR 4.42, 95% CI 2.05-9.52) and mortality (OR 0.27, 95% CI 0.13-0.57). Independent individual elements contributing to clinical success were removal of central venous catheters within 24 h, assessment of clinical efficacy on the third to the fifth day and at least 2 weeks of therapy after clearance of candidaemia. Conclusions: Compliance with the bundles for candidaemia had a beneficial effect on clinical outcomes. Promotion of the bundles approach may have the potential to narrow the gap between clinical evidence and bedside practice.

KW - Candidiasis

KW - Fungal infections

KW - Guidelines

KW - Intravenous catheters

KW - Invasive disease

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