カンジダ血症治療バンドルに基づいた薬剤師の早期介入と連日のフォローアップにおける臨床的有効性の評価

抄録

Candidemia is associated with high mortality; therefore, early and appropriate treatment is important. This study evaluated the effectiveness of a pharmacist-led rapid intervention system based on the candidemia treatment bundle (bundle) on clinical outcomes. The study cohort was divided into preintervention (January 1, 2012 to December 31, 2013) and postintervention (April 1, 2014 to December 31, 2021) groups involving hospitalized patients with Candida species detected in blood cultures and treated with antifungal drugs. The bundle comprised six elements: early initiation of antifungal therapy, appropriate selection of the initial antifungal drug, early control of the infection focus, follow-up of blood cultures, appropriate treatment duration, and investigation of intraocular inflammation. The primary outcome focused on the compliance rate with the bundle, and the secondary outcome included 30-day mortality rates and clinical outcomes. The preintervention group comprised 21 cases, while the postintervention group involved 71 cases. The overall bundle compliance increased significantly from 9.5％ preintervention to 53.5％ postintervention (P < 0.001). The compliance rates for the follow-up of blood cultures increased significantly from 71.4％ to 98.6％ (P = 0.005). Although the other elements increased, they did not reach statistical significance. No significant difference was found in the 30-day mortality between interventions (28.6％ vs 23.9％, P = 0.775). Pharmacists taking a central role and intervening early based on the bundle contribute to improving the quality of candidemia treatment.