Management bundles for candidaemia: the impact of compliance on clinical outcomes.
Management bundles for candidaemia: the impact of compliance on clinical outcomes.
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DOI：
10.1093/jac/dku414
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发表时间：
2015-02
期刊：
影响因子：
--
通讯作者：
ACTIONs Project
中科院分区：
文献类型：
--
作者：
Takesue Y;Ueda T;Mikamo H;Oda S;Takakura S;Kitagawa Y;Kohno S;ACTIONs Project
日本的真菌病论坛已经开发了念珠菌血症管理包，以纳入床边实践。本研究的目的是调查全国范围内的遵守捆绑及其对临床结果的影响。调查了接受抗真菌药治疗念珠菌血症的非血小板减少症患者。捆绑包由九个项目组成。数据于2011年7月至2012年4月期间发送到中央办公室。共分析了608例患者。实现所有要素的依从率为6.9%，当按束分析依从性时，除口腔开关外，依从率增加到21.4%。有依从性和无依从性患者的临床成功率存在显著差异[92.9% vs 75.8%（P = 0.011）]。 然而，遵守捆绑包并不是与有利结果相关的独立因素。当降压口服治疗被排除在依从性因素之外时，对捆绑治疗的依从性被认为是临床成功（OR 4.42，95%CI 2.05-9.52）和死亡率（OR 0.27，95%CI 0.13-0.57）的独立预测因子。有助于临床成功的独立个体因素是在24小时内移除中心静脉导管，在第三至第五天评估临床疗效，以及在清除念珠菌血症后至少治疗2周。遵守束念珠菌血症有有益的影响，临床结果。推广捆绑方法可能有可能缩小临床证据和床边实践之间的差距。
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. 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. 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. 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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