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Use of the PATH Alliance database to measure adherence to IDSA guidelines for the therapy of candidemia

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Abstract

Candidemia is an increasing complication of the care of complex patients. Adherence to Infectious Diseases Society of America (IDSA) guidelines for the treatment of candidemia was investigated to assess the impact of compliance on outcomes of therapy. Data on the epidemiology, diagnosis, and treatment of patients with invasive fungal infections (IFIs) was extracted from the PATH Alliance registry, a prospective, multicenter, observational database of invasive fungal infections. Patients with proven candidemia were evaluated for adherence to the IDSA guidelines in terms of choice, dosage, and duration of antifungal therapy. Removal of central venous catheters and time to treatment initiation were assessed. Four-week survival data were compared. Of the 418 patients with candidemia who were included in the study, 361 patients with the necessary data sets were identified, of whom 262 (72.6%) were treated within the IDSA guidelines for the treatment of candidemia (IDSA group); the remaining 99 (27.4%) patients received treatment different from the guidelines (non-IDSA group). Kaplan-Meier (KM) survival analysis for patients in the IDSA and non-IDSA group showed mortality rates of 21.9 and 13.6%, respectively; the difference between the two groups was not statistically significant (P = 0.093). Following the exclusion of patients requiring mechanical ventilation or acute cardiac support, the modified survival KM curves were similar between the two groups. Significantly more patients in the IDSA group required mechanical ventilation and tunneled central catheters, had a concomitant IFI, and received caspofungin. The duration of treatment and inappropriate dosing did not appear to have had a significant impact on survival. Most of the deviations from IDSA guidelines were due to the inappropriate duration and dosing of therapy. No significant difference in mortality was noted between the IDSA and non-IDSA groups. The basis of these differences merit further study.

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Acknowledgments

This project would not be possible without the support and guidance provided by Axiom Real-Time Metrics, Inc. and The Synapse Group, Ltd. The authors would like to thank Dr. Chi-Hsing Chang for the statistical analysis and gratefully acknowledge Karen Webster and Sue Elliott for their significant contribution in completing this project.

Financial support

Astellas provided assistance with the study design and statistical analysis.

Potential conflict of interest

D.H. has received grant support (research) from Astellas and Pfizer, has been a consultant for Astellas and on the speakers’ bureau for Astellas and Pfizer.

D.N. has received grant support (research) from Astellas.

J.F. has been a consultant to Gilead, Merck Inc., FDA/CBER-Xenotransplantation, Biogen-IDEC, Hoffman LaRoche, Athelas, ViroPharma, Astellas, Primera, is a member of the DSMB for Immune Tolerance Network-NIAID-NIH Transplantation Trials, has received grant support (educational/research) by Astellas, and has been on the speakers’ bureau for Astellas, Roche, Pfizer, and Gilead.

W.S. has served as consultant to Pfizer, Astellas, and Schering-Plough.

E.A. has been a consultant to and on the speakers’ bureau for Astellas, Pfizer, Gilead, Merck, and Schering-Plough.

K.A.M. has been a consultant to Pfizer, Merck, Enzon, Astellas, and Schering-Plough.

M.P. has been a consultant to and on the speakers’ bureau for Pfizer, Astellas, Merck, and Schering-Plough.

A.O. has been on the speakers’ bureau for Pfizer.

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Authors and Affiliations

  1. Division of Infectious Diseases, Thomas Jefferson University Hospital, 211 South 9th Street, Suite 210, Philadelphia, PA, 19107, USA

    D. Horn & D. Neofytos

  2. Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Jackson 504, Boston, MA, 02114, USA

    J. Fishman

  3. Division of Pediatric Infectious Diseases, Duke University Medical Center, Room 00541 Blue Zone, Duke South, Durham, NC, 27710, USA

    W. Steinbach

  4. Division of Supportive Care, Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 816, Little Rock, AR, 72205, USA

    E. Anaisie

  5. Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N. D3-100, Seattle, WA, 98119, USA

    K. A. Marr

  6. Department of Pathology, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, IA, 52242, USA

    M. Pfaller

  7. Divisions of Infectious Diseases and Nephrology and Hypertension, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA

    K. A. Marr & A. Olyaei

Authors
  1. D. Horn
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  2. D. Neofytos
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  3. J. Fishman
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  4. W. Steinbach
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  5. E. Anaisie
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  6. K. A. Marr
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  7. M. Pfaller
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  8. A. Olyaei
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Corresponding author

Correspondence to D. Horn.

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Horn, D., Neofytos, D., Fishman, J. et al. Use of the PATH Alliance database to measure adherence to IDSA guidelines for the therapy of candidemia. Eur J Clin Microbiol Infect Dis 26, 907–914 (2007). https://doi.org/10.1007/s10096-007-0383-4

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  • DOI: https://doi.org/10.1007/s10096-007-0383-4

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