For patients with fungal infections, specialists save lives

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Infectious disease specialists overseeing care of patients with fungal infections in the bloodstream can cut death rates by 20%, according to a new study.

Bloodstream infections that the fungus Candida causes are among the most common and deadly infections in hospitals, with 25,000 such cases seen annually in the US—mostly in people originally hospitalized for other reasons. About 40% to 45% of people die of the infection, around 10,000 people die every year.

Specialists are more likely to follow evidence-based best practices for treating infections, likely why their patients do better, the researchers say. The findings, which appear in Lancet Infectious Diseases, suggest that physicians should not hesitate to consult with infectious disease doctors if they suspect a fungal bloodstream infection.

“Candida infections are a major problem in hospitals large and small across the country,” says senior author Andrej Spec, an assistant professor of medicine at Washington University in St. Louis and associate director of the Infectious Diseases Clinical Research Unit and director of the Invasive Fungal Infections Clinic.

“Even uncomplicated versions of these infections are actually quite dangerous and require a detailed and well-thought out approach to make sure that people do well. Infectious disease doctors are the ones who have the expertise to best treat these infections.”

Even in major medical centers, it has not been the standard of care to call in an infectious disease physician to help treat fungal bloodstream infections, says coauthor William G. Powderly, professor of medicine. “But our study indicates that bringing in a specialist to consult on such infections should be the standard of care. We’re taking steps to adopt this protocol for our patients.”

Large hospitals usually have an infectious disease physician on staff, but these experts may be rare in smaller community hospitals.

To find out whether infectious disease specialists improve outcomes, first author Carlos Mejia-Chew, an instructor in infectious diseases, worked with Spec and colleagues to analyze data from 1,691 patients with Candida bloodstream infections treated at Barnes-Jewish Hospital in St. Louis from 2002 to 2015.

The team looked at what steps doctors took to treat each infection, including whether they consulted with infectious disease specialists, and how many patients were still alive 90 days after diagnosis.

Nearly half (45.9%) of the physicians with primary responsibility for the patients consulted with infectious disease specialists. Of the patients an infectious disease expert evaluated, 28.6% died within 90 days. But of those whose doctors did not call the specialists, 50.5% died. Even after correcting for risk factors such as age and underlying disease, the benefit of a specialist consultation translated into a 20% lower risk of death.

When infectious disease experts took part in care, patients were more likely to receive treatments proven to save lives. More of the patients received antifungal medications, and they stayed on the drugs longer. Infectious disease doctors more likely checked for serious complications such as infections of the heart. Perhaps most importantly, infectious disease physicians were more likely to remove central line catheters used to administer IV medications.

“A lot of times doctors hesitate to remove central lines because they’re necessary for the care of the patient and once you take it out it’s hard to put a new one in,” Spec says. “But these catheters are also often the source of the infection. When you’re looking at a 40% chance of death, it’s really important to stack the deck in the patient’s favor by getting rid of the source of infection.”

Source: Washington University in St. Louis