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Título: | An evidence-based bundle improves the quality of care and outcomes of patients with candidaemia |
Autor: | Cardozo, Celia; Cuervo, Guillermo; Salavert, Miguel; Merino, Paloma; Gioia, Francesca; Fernández-Ruiz, Mario; López-Cortés, Luis Eduardo; Escolà‐Vergé, Laura; Montejo, Miguel; Muñoz, Patricia; Aguilar Guisado, Manuela CSIC ORCID; Puerta-Alcalde, Pedro; Tasias Pitarch, M.; Ruiz-Gaitán, Alba; González, Fernando; Puig-Asensio, M.; Vena, Antonio; Marco, Francesc; Pemán, Javier; Fortún, Jesús; Aguado, José María; Almirante, Benito; Soriano, Álex; Carratalà, Jordi; García‐Vidal, Carolina | Palabras clave: | Quality of care Septic shock Follow-up Mortality Candidemia Blood culture Evidence-based practice Introduction |
Fecha de publicación: | mar-2020 | Editor: | Oxford University Press | Citación: | Journal of Antimicrobial Chemotherapy 75(3): 730-737 (2020) | Resumen: | [Background] Candidaemia is a leading cause of bloodstream infections in hospitalized patients all over the world. It remains associated with high mortality. [Objectives] To assess the impact of implementing an evidence-based package of measures (bundle) on the quality of care and outcomes of candidaemia. [Methods] A systematic review of the literature was performed to identify measures related to better outcomes in candidaemia. Eight quality-of-care indicators (QCIs) were identified and a set of written recommendations (early treatment, echinocandins in septic shock, source control, follow-up blood culture, ophthalmoscopy, echocardiography, de-escalation, length of treatment) was prospectively implemented. The study was performed in 11 tertiary hospitals in Spain. A quasi-experimental design before and during bundle implementation (September 2016 to February 2018) was used. For the pre-intervention period, data from the prospective national surveillance were used (May 2010 to April 2011). [Results] A total of 385 and 263 episodes were included in the pre-intervention and intervention groups, respectively. Adherence to all QCIs improved in the intervention group. The intervention group had a decrease in early (OR 0.46; 95% CI 0.23–0.89; P = 0.022) and overall (OR 0.61; 95% CI 0.4–0.94; P = 0.023) mortality after controlling for potential confounders. [Conclusions] Implementing a structured, evidence-based intervention bundle significantly improved patient care and early and overall mortality in patients with candidaemia. Institutions should embrace this objective strategy and use the bundle as a means to measure high-quality medical care of patients. |
Descripción: | GEMICOMED (SEIMC) and the Spanish CANDI-Bundle Group. | Versión del editor: | http://doi.org/10.1093/jac/dkz491 | URI: | http://hdl.handle.net/10261/229037 | DOI: | 10.1093/jac/dkz491 | Identificadores: | doi: 10.1093/jac/dkz491 issn: 0305-7453 e-issn: 1460-2091 |
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