European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026
Impact of a pharmacist-led infectious disease support team on candidemia bundle adherence and 28-day mortality: a single-center retrospective cohort study.
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Endo Aiju, Hanai Yuki, Mikawa Takahiro, Asakawa Daiki, Ishibe Taiki, Nakane Yu, Tanaka Misako, Mitsui Daichi, Kido Shinji, Nonaka Takeshi, Fujimori Ken, Kudo Nozomi, Nakadoi Yuta, Kobayashi Yukimasa, Negishi Rintaro, Fujimori Ayaka, Takatori Mika, Natsume Yasuyuki, Matsumoto Kaori, Matsumoto Kazuaki
Аннотация
PURPOSE: The clinical value of pharmacist-led multidisciplinary support for candidemia is poorly established. This study examines whether shifting from an antimicrobial stewardship team (AST) to a pharmacist-led infectious disease support team (IDST) model improves bundle adherence and clinical outcomes among patients with candidemia.
METHODS: This retrospective cohort study at Yamanashi Prefectural Central Hospital included hospitalized patients with at least one positive blood culture set for Candida spp. from April 2018 to September 2025. Patients who died within 48 h of candidemia confirmation or had unknown 28-day survival status were excluded. The primary outcome was adherence to an 8-item candidemia treatment bundle; secondary outcomes were 28-day mortality and microbiological eradication rates. Clinical outcomes and risk factors were analyzed using Kaplan-Meier and Cox proportional hazards models.
RESULTS: This study included 89 patients with a median age of 74 years. Candida albicans emerged as the predominant pathogen. In total, 61.8% of participants achieved bundle adherence of at least 75%. The IDST group demonstrated significantly higher adherence to multiple bundle components and a higher overall achievement rate compared with the non-IDST group. Additionally, the IDST group exhibited lower 28-day mortality (29.2% vs. 56.1%, P = 0.019) and higher microbiological eradication rates (87.5% vs. 61.0%, P = 0.006). Multivariable Cox analysis revealed that IDST intervention was independently associated with reduced 28-day mortality (hazard ratio: 0.452; 95% confidence interval: 0.220-0.926, P = 0.030).
CONCLUSION: IDST intervention is associated with improved adherence to the candidemia bundle, lower 28-day mortality, and higher microbiological eradication rates.
METHODS: This retrospective cohort study at Yamanashi Prefectural Central Hospital included hospitalized patients with at least one positive blood culture set for Candida spp. from April 2018 to September 2025. Patients who died within 48 h of candidemia confirmation or had unknown 28-day survival status were excluded. The primary outcome was adherence to an 8-item candidemia treatment bundle; secondary outcomes were 28-day mortality and microbiological eradication rates. Clinical outcomes and risk factors were analyzed using Kaplan-Meier and Cox proportional hazards models.
RESULTS: This study included 89 patients with a median age of 74 years. Candida albicans emerged as the predominant pathogen. In total, 61.8% of participants achieved bundle adherence of at least 75%. The IDST group demonstrated significantly higher adherence to multiple bundle components and a higher overall achievement rate compared with the non-IDST group. Additionally, the IDST group exhibited lower 28-day mortality (29.2% vs. 56.1%, P = 0.019) and higher microbiological eradication rates (87.5% vs. 61.0%, P = 0.006). Multivariable Cox analysis revealed that IDST intervention was independently associated with reduced 28-day mortality (hazard ratio: 0.452; 95% confidence interval: 0.220-0.926, P = 0.030).
CONCLUSION: IDST intervention is associated with improved adherence to the candidemia bundle, lower 28-day mortality, and higher microbiological eradication rates.