P-1747. Optimizing Candidaemia Management: Antifungal Stewardship and Diagnostic Practices in a UK Tertiary Centre

TL;DR

This study examines antifungal treatment and diagnostic practices for candidaemia in a UK hospital to improve patient outcomes.

Contribution

The study provides real-world insights into antifungal stewardship and diagnostic practices for candidaemia in a UK tertiary center.

Findings

96.4% of patients received appropriate initial antifungal therapy, with caspofungin being the most common initial agent.

Repeat blood cultures were performed in 46.2% of non-palliative patients, with a median clearance time of 3 days.

Fluconazole step-down therapy was used in 60.7% of patients, showing adherence to guideline-recommended practices.

Abstract

Candidaemia is associated with high mortality and increasing incidence, particularly in critical care and post-surgical settings. Guideline-concordent management, including prompt antifungal therapy, repeat cultures, source control, and investigation for metastatic complications, is essential for improving outcomes. This study evaluated real-world practice patterns in antifungal use, microbiological monitoring in a UK teaching hospital.Summary of antifungal usageSummary of antifungal usage and dosageAntifungal usage Patterns in Candidaemia cohortAntifungal usage Patterns in Candidaemia cohort

Summary of antifungal usage

Summary of antifungal usage and dosage

Antifungal usage Patterns in Candidaemia cohort

Antifungal usage Patterns in Candidaemia cohort

A retrospective review was conducted of all inpatients with candida species positive blood cultures between June 1, 2022 and June 1, 2023. Data from the laboratory information Management system and case notes were analysed for organism identification with susceptibility, treatment regimens and microbiological follow-up.Frequency of repeat blood culturesFrequency of repeat blood cultures: Number of days

Frequency of repeat blood cultures

Frequency of repeat blood cultures: Number of days

Twenty-eight patients met inclusion criteria. Species identification was successful in all cases; susceptibility testing was performed in 96.4%. The most common species were C.albicans(50%), C.glabrata( 28.6%), and C.parapsilosis(21.4%). Repeat blood cultures were taken in 46.2% of non-palliative patients(see figure 1), with a median clearance time of 3 days. Antifungal therapy was appropriately initiated in 96.4% of patients, with 89.5% receiving treatment for a guideline-recommended duration of (median 19 days). Caspofungin was the initial agent in 89.3% of cases; Fluconazole step-down therapy( IV to Oral) was used in 60.7% of patients(see table 1).

This single-centre study demonstrates strong adherence to antifungal prescribing guidlines and effective diagnostic stewardship. Nonetheless, improvements are needed in the consistency of repeat blood cultures. Optimising antifungal and diagnostic stewardship areas may further reduce morbidity and mortality in patients with candidaemia.

All Authors: No reported disclosures

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