Impact of Pharmacists' Intervention on Antifungal Therapy Decisions for Candidemia (Part One)

Abstract

OBJECTIVES: The overall objective of this project is to conduct an evaluation of the impact of pharmacists’ early interventions on clinical outcomes in patients with candidemia infections using a new microbiology assay, peptide nucleic acid fluorescence in situ hybridization (PNA FISH). The primary purpose of part one of the project was to evaluate timing of antifungal therapy decisions for candidemia and patient outcomes prior to implementation of the PNA FISH assay. A second part of this project will evaluate patient outcomes and timing of antifungal therapy decisions after implementation of planned pharmacists' early intervention based on candida species determination by the PNA FISH assay. METHODS: In this part one IRB-­‐approved, retrospective study, all patients with a Candida species isolated from blood at a tertiary medical center during a one-­‐year period were reviewed. Subjects were excluded from analyses if discharged alive prior to the final blood culture report for the index Candida species isolated. The time to proper antifungal therapy in relation to timing of blood culture, detection of candida growth, and determination of candida species were evaluated. The second part of this study is IRB-­‐approved and data collection is currently in progress for a second one-­‐year period after implementation of the PNA FISH assay for Candida species. During the second part of this study, designated pharmacists provided antifungal therapy recommendations based on PNA FISH results to each patient's healthcare team. RESULTS: n part one of this study, a total of 61 patients with candidemia were evaluated. The majority of candida infections were caused by either C. albicans (n=24) or C. glabrata (n=11). Prior to implementation of the PNA FISH assay, the mean time to final identification of C. albicans was 82.4 +/-­‐ 19.2 hours while the mean time for C. glabrata was 143 +/-­‐ 39.2 hours (p < 0.0001). The mean time to detection of candida growth, which is approximately the time PNA FISH assay performed in part two of project, was 31.2 +/-­‐ 19.8 hours. Planned data analysis will include comparison of time to appropriate antifungal therapy and clinical patient outcomes between part one and part two patient populations. CONCLUSIONS: The preliminary results of this part 1 of 2 studies provides the baseline data for comparison of antifungal therapy decisions for candidemia pre-­‐ and post-­‐ implementation of pharmacists' intervention based on PNA FISH results.