An evidence-based bundle improves the quality of care and outcomes of patients with candidaemia
© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissionsoup.com..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:75 |
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| Enthalten in: |
The Journal of antimicrobial chemotherapy - 75(2020), 3 vom: 01. März, Seite 730-737 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Cardozo, Celia [VerfasserIn] |
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| Links: |
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| Themen: |
Journal Article |
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| Anmerkungen: |
Date Completed 24.06.2021 Date Revised 24.06.2021 published: Print Citation Status MEDLINE |
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| doi: |
10.1093/jac/dkz491 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM304214531 |
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| 100 | 1 | |a Cardozo, Celia |e verfasserin |4 aut | |
| 245 | 1 | 3 | |a An evidence-based bundle improves the quality of care and outcomes of patients with candidaemia |
| 264 | 1 | |c 2020 | |
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| 500 | |a Date Completed 24.06.2021 | ||
| 500 | |a Date Revised 24.06.2021 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissionsoup.com. | ||
| 520 | |a BACKGROUND: Candidaemia is a leading cause of bloodstream infections in hospitalized patients all over the world. It remains associated with high mortality | ||
| 520 | |a OBJECTIVES: To assess the impact of implementing an evidence-based package of measures (bundle) on the quality of care and outcomes of candidaemia | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Systematic Review | |
| 700 | 1 | |a Cuervo, Guillermo |e verfasserin |4 aut | |
| 700 | 1 | |a Salavert, Miguel |e verfasserin |4 aut | |
| 700 | 1 | |a Merino, Paloma |e verfasserin |4 aut | |
| 700 | 1 | |a Gioia, Francesca |e verfasserin |4 aut | |
| 700 | 1 | |a Fernández-Ruiz, Mario |e verfasserin |4 aut | |
| 700 | 1 | |a López-Cortés, Luis E |e verfasserin |4 aut | |
| 700 | 1 | |a Escolá-Vergé, Laura |e verfasserin |4 aut | |
| 700 | 1 | |a Montejo, Miguel |e verfasserin |4 aut | |
| 700 | 1 | |a Muñoz, Patricia |e verfasserin |4 aut | |
| 700 | 1 | |a Aguilar-Guisado, Manuela |e verfasserin |4 aut | |
| 700 | 1 | |a Puerta-Alcalde, Pedro |e verfasserin |4 aut | |
| 700 | 1 | |a Tasias, Mariona |e verfasserin |4 aut | |
| 700 | 1 | |a Ruiz-Gaitán, Alba |e verfasserin |4 aut | |
| 700 | 1 | |a González, Fernando |e verfasserin |4 aut | |
| 700 | 1 | |a Puig-Asensio, Mireia |e verfasserin |4 aut | |
| 700 | 1 | |a Vena, Antonio |e verfasserin |4 aut | |
| 700 | 1 | |a Marco, Francesc |e verfasserin |4 aut | |
| 700 | 1 | |a Pemán, Javier |e verfasserin |4 aut | |
| 700 | 1 | |a Fortún, Jesús |e verfasserin |4 aut | |
| 700 | 1 | |a Aguado, José María |e verfasserin |4 aut | |
| 700 | 1 | |a Almirante, Benito |e verfasserin |4 aut | |
| 700 | 1 | |a Soriano, Alejandro |e verfasserin |4 aut | |
| 700 | 1 | |a Carratalá, Jordi |e verfasserin |4 aut | |
| 700 | 1 | |a Garcia-Vidal, Carolina |e verfasserin |4 aut | |
| 700 | 0 | |a GEMICOMED (SEIMC) and the Spanish CANDI-Bundle Group |e verfasserin |4 aut | |
| 700 | 1 | |a Martínez, J A |e investigator |4 oth | |
| 700 | 1 | |a Morata, L |e investigator |4 oth | |
| 700 | 1 | |a Rodríguez-Nuñez, O |e investigator |4 oth | |
| 700 | 1 | |a Guerrero, M A |e investigator |4 oth | |
| 700 | 1 | |a Ayats, J |e investigator |4 oth | |
| 700 | 1 | |a Grau, I |e investigator |4 oth | |
| 700 | 1 | |a Calabuig, E |e investigator |4 oth | |
| 700 | 1 | |a Castro, I |e investigator |4 oth | |
| 700 | 1 | |a Cuéllar, S |e investigator |4 oth | |
| 700 | 1 | |a Martín-Dávila, P |e investigator |4 oth | |
| 700 | 1 | |a Gómez-García de la Pedrosa, E |e investigator |4 oth | |
| 700 | 1 | |a Pérez-Ayala, A |e investigator |4 oth | |
| 700 | 1 | |a Losada, I |e investigator |4 oth | |
| 700 | 1 | |a Navarro, M D |e investigator |4 oth | |
| 700 | 1 | |a Suarez, A I |e investigator |4 oth | |
| 700 | 1 | |a Martin-Gomez, M T |e investigator |4 oth | |
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| 700 | 1 | |a López-Soira, L |e investigator |4 oth | |
| 700 | 1 | |a Bouza, E |e investigator |4 oth | |
| 700 | 1 | |a Guinea, J |e investigator |4 oth | |
| 700 | 1 | |a Martín, C |e investigator |4 oth | |
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