749 - Impact of Infectious Disease Consultation in Patients with Candidemia: A Retrospective study, Systematic Literature Review and Meta-analysis

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Presenting Author(s)

Takaaki Kobayashi

Infectious disease fellow physician
University of Iowa Hospitals and Clinics
Iowa City, Iowa
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

AM

Alexandre Marra

Research assistant
University of Iowa Hospital and Clinics
iowa city, Iowa
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Marin L. Schweizer

Associate Professor
University of Iowa Carver College of Medicine
Iowa City, Iowa
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
PT

Patrick Ten Eyck

Assistant Director for Biostatistics and Research Design
n/a
Iowa City, Iowa
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CW

Chaorong Wu

statistician
University of Iowa
Iowa City, Iowa
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MA

Mohammed Alzunitan

Hospital epidemiology fellow
University of Iowa
Iowa City, Iowa
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JS

Jorge L. Salinas

Clinical Assistant Professor
University of Iowa Hosptials and Clinics
Iowa City, IA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MS

Marc O. Siegel

Associate Professor of Medicine
George Washington University School of Medicine and Health Sciences
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Dimitrios Farmakiotis

Assistant Professor, Director of Transplant and Oncology ID
Division of Infectious Diseases, The Warren Alpert Medical School of Brown University
Providence, Rhode Island
Disclosure: Astellas (Grant/Research Support)
Paul G. Auwaerter

Clinical Director, Professor of Medicine
Johns Hopkins University School of Medicine
Lutherville, Maryland
Disclosure: Collidion (Consultant)DiaSorin (Consultant)Johnson and Johnson (Shareholder)MicroB-Plex (Research Grant or Support)Shionogi (Consultant)
HH

Heather Healy

Clinical Education Librarian
Hardin Library for the Health Sciences, University of Iowa
Iowa City, Iowa
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Daniel Diekema

Professor, Division of Infectious Diseases
University of Iowa Hospitals and Clinics
Iowa City, Iowa
Disclosure: bioMerieux, Inc (Grant/Research Support)JMI Laboratories (Consultant)

Background: Morbidity and mortality from candidemia remain unacceptably high. While infectious disease consultation (IDC) is known to lower the mortality from Staphylococcus aureus bacteremia, little is known on the impact of IDC in candidemia.

Methods: We conducted a retrospective observational cohort study of candidemia patients at a large tertiary care hospital between 2015 and 2019. All patients aged ≥18 years with blood cultures positive for Candida species were included. We only included the first episode of candidemia. Exclusion criteria were death or transfer to the palliative care unit within 48 hours from the time cultures became positive. The crude mortality rate was compared between those with IDC and without IDC. Then, we systematically searched five publication-databases through February 2020 and performed a meta-analysis of the impact of IDC on mortality of patients with candidemia. The study protocol has been submitted to the International Prospective Register for Systematic Reviews (PROSPERO) database (ID 156939) on April 2020.

Results: A total of 151 patients at our institution met the inclusion criteria, 129 (85%) of whom received IDC. Thirty-day, and 90-day mortality rates were significantly lower in the IDC group (18% vs 50%, P = .002; 23% vs 50%, P = .0022, respectively). Our systematic literature review returned 216 reports, of which, 13 studies including ours fulfilled the inclusion criteria. Among the 13 studies with a total 3687 patients, IDC was performed in 49% of patients. Mortality numbers were available in 10 studies. Overall mortality was 38.2% with a significant difference in favor of the IDC group (28.4% and 47.6%) with a pooled relative risk of 0.41 [95% Cl 0.35-0.49]. Ophthalmology referral (61%; 790/1279 and 21%; 273/1304, P < 0.001), echocardiogram (54%; 662/1219 and 28%; 369/1296, P < 0.001), and central line removal (78%; 830/1069 and 61%; 686/1116, P < 0.02) were performed more frequently among patients receiving IDC.Overall mortality

Conclusion: This study is the first systematic literature review and meta-analysis to evaluate the association between IDC and candidemia mortality. IDC was associated with a lower mortality and should be standard of care in all patients with candidemia.