Antimicrobial stewardship without infectious disease physician for patients with candidemia: A before and after study.

BACKGROUND: Little is known about the effects of antimicrobial stewardship team (AST) without infectious disease physician (IDP) on clinical outcome in patients with candidemia. METHODS: We conducted a before and after study involving patients with hospital-acquired candidemia at a tertiary hospital without IDPs. The AST consisted of physicians, pharmacists, nurse, microbiologist, and administrative staff. A candidemia care bundle was developed based on the Infectious Disease Society of America (IDSA) guideline. The non-IDP AST provided recommendations to the attending physicians whose patients developed candidemia during hospitalization. The primary outcome was 30-day all-cause mortality, while the secondary outcomes were adherence to the IDSA guidelines regarding the management of candidemia. Data of up to 3 years of preintervention and 3 years of intervention period were analyzed. RESULTS: By 30 days, 11 of 46 patients (23.9%) in the intervention group and 7 of 30 patients (23.3%) in the preintervention group died (adjusted hazard ratio for the intervention group: 0.68 [95% CI 0.24-1.91]). The non-IDP AST was associated with appropriate empirical antifungal therapy (100% vs 60.0%; proportion ratio 1.67 [95% CI 1.24-2.23]), appropriate duration of treatment (84.7% vs 43.3%; 1.96 [1.28-3.00]), removal of central venous catheters (94.4% vs 70.8%; 1.33 [1.02-1.74]), and ophthalmological examination (93.5% vs 63.3%; 1.48 [1.12-1.96]). CONCLUSIONS: Although we found no significant difference in 30-day mortality, the non-IDP AST was associated with improved adherence to guidelines for management of candidemia.

[Penicillium marneffei isolated from a Thai AIDS patient with fungemia].

Penicillium marneffei was isolated from three blood cultures of a Thai woman with AIDS and then identified as such. The patient, 41 a year-old female from northeast Thailand came to Japan 10 years ago and married a Japanese man. She was reportedly the third patient infected with this fungal species in Japan, and considered to be the first case from whom the causative fungus was successfully cultured, which led to the diagnosis of penicilliosis marneffei. The colony of the isolate, which was cultured on Sabouraud dextrose agar at 25-27 degrees C, was initially white and pannose, gradually turned in color from yellow to yellow-green, and diffused a deep red pigment into the medium. Conidial heads were divergent, and chains of conidia were formed from phialides. Colonies of the isolate, which was cultured on brain-heart infusion agar at 35 degrees C, had a grayish white, membranous yeast-like form with fine plicae and microscopically consisted of short hyphae. Furthermore, 560 bases of the internal transcribed spacer (ITS) region of the ribosomal RNA gene including the 5.8S region (ITS1-5.8S-ITS2) (DDBJ accession number AB298970) were sequenced and allowed an unequivocal species identification.

[Antimicrobial susceptibility and beta-lactamase productivity of recent clinical isolates during the period between December 1999 and February 2000].

Antimicrobial susceptibility testings of 24 antimicrobial agents against 605 clinical strains belonging to 10 species were carried out according to the micro-broth dilution method of NCCLS M7-A4. The productivity of beta-lactamase was also determined against them isolated at 8 medical facilities in Nagano prefecture, Japan during the period between December 1999 and February 2000. When applied the nitrocefin method, beta-lactamase productivity was demonstrated to be positive for 89.2% of 74 S. aureus, 4.3% of 94 H. influenzae, and 100% of 69 M. (B.) catarrhalis isolates. On the other hand, when used the acidometry method, penicillinase/cephalosporinase were found to be positive for 21.2%/9.6% of 52 E. coli, 29.0%/3.2% of 31 K. pneumoniae, 53.2%/100% of 47 E. cloacae, 0%/11.1% of 99 S. marcescens, and 25.9%/55.6% of 54 P. aeruginosa isolates, respectively. Among the beta-lactamase-producers including P. aeruginosa isolates, only 2 E. coli isolates were found to be ESBL-producers. Besides, 9.6% (9/94) of H. influenzae isolates were proved to be BLNAR strains.