Nicholai De La Cruz , Ann Whitaker , Nicholas Rukin , Kevin O'Callaghan
{"title":"降低泌尿科患者的念珠菌血症风险：修订算法与药剂师主导的实施。","authors":"Nicholai De La Cruz , Ann Whitaker , Nicholas Rukin , Kevin O'Callaghan","doi":"10.1016/j.idh.2024.06.001","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Candidaemia is an invasive infection with high morbidity and mortality. All urology procedures carry risk of post-operative infection. Risk mitigation strategies include preoperative urine culture and treatment of cultured organism(s) regardless of symptoms. After zero cases of candidaemia for two years, there were five cases in elective urology patients within 15 weeks between June – September 2021. This increased incidence of candidaemia amongst these patients prompted multidisciplinary investigation.</p></div><div><h3>Methods</h3><p>Single centre case series, in a 250-bed hospital which annually performs 2000-2500 elective urology surgeries. Affected patients were elderly with multiple comorbidities. Notably, four of five patients had prior indwelling ureteral stents. All five patients had preoperative bacteriuria requiring antibiotics and one patient had pre-operative candiduria.</p></div><div><h3>Results</h3><p>Hypotheses including sterilisation failure, surgical instrument contamination, or surgical technique issues were unfounded. We propose that pre-operative duration of antibacterial therapy, particularly in the setting of ureteral stent biofilm, is a significant factor for candiduria. A new prescribing algorithm for urology patients was devised. Antibiotic treatment duration in asymptomatic patients with indwelling urinary tract foreign material was reduced from 14 to 3 days, and from 14 to 7 days in symptomatic patients. Dedicated pharmacist resources were allocated to support this change and pre-operatively manage these patients. These interventions led to zero candidaemia cases over the subsequent 21 months, along with zero post-operative bacterial bloodstream infections.</p></div><div><h3>Conclusions</h3><p>Prolonged pre-operative antibacterial therapy poses a risk for post-operative candidaemia, especially in patients with ureteral stents. Shortening pre-operative antibiotic courses, coupled with increased pharmacist involvement, effectively reduced candidaemia incidence.</p></div>","PeriodicalId":45006,"journal":{"name":"Infection Disease & Health","volume":"29 4","pages":"Pages 227-232"},"PeriodicalIF":2.7000,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Reducing candidaemia risk in urology patients: Revised algorithm & Pharmacist-Led Implementation\",\"authors\":\"Nicholai De La Cruz , Ann Whitaker , Nicholas Rukin , Kevin O'Callaghan\",\"doi\":\"10.1016/j.idh.2024.06.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Candidaemia is an invasive infection with high morbidity and mortality. All urology procedures carry risk of post-operative infection. Risk mitigation strategies include preoperative urine culture and treatment of cultured organism(s) regardless of symptoms. After zero cases of candidaemia for two years, there were five cases in elective urology patients within 15 weeks between June – September 2021. This increased incidence of candidaemia amongst these patients prompted multidisciplinary investigation.</p></div><div><h3>Methods</h3><p>Single centre case series, in a 250-bed hospital which annually performs 2000-2500 elective urology surgeries. Affected patients were elderly with multiple comorbidities. Notably, four of five patients had prior indwelling ureteral stents. All five patients had preoperative bacteriuria requiring antibiotics and one patient had pre-operative candiduria.</p></div><div><h3>Results</h3><p>Hypotheses including sterilisation failure, surgical instrument contamination, or surgical technique issues were unfounded. We propose that pre-operative duration of antibacterial therapy, particularly in the setting of ureteral stent biofilm, is a significant factor for candiduria. A new prescribing algorithm for urology patients was devised. Antibiotic treatment duration in asymptomatic patients with indwelling urinary tract foreign material was reduced from 14 to 3 days, and from 14 to 7 days in symptomatic patients. Dedicated pharmacist resources were allocated to support this change and pre-operatively manage these patients. These interventions led to zero candidaemia cases over the subsequent 21 months, along with zero post-operative bacterial bloodstream infections.</p></div><div><h3>Conclusions</h3><p>Prolonged pre-operative antibacterial therapy poses a risk for post-operative candidaemia, especially in patients with ureteral stents. Shortening pre-operative antibiotic courses, coupled with increased pharmacist involvement, effectively reduced candidaemia incidence.</p></div>\",\"PeriodicalId\":45006,\"journal\":{\"name\":\"Infection Disease & Health\",\"volume\":\"29 4\",\"pages\":\"Pages 227-232\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2024-07-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Infection Disease & Health\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2468045124000312\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Infection Disease & Health","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2468045124000312","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
Candidaemia is an invasive infection with high morbidity and mortality. All urology procedures carry risk of post-operative infection. Risk mitigation strategies include preoperative urine culture and treatment of cultured organism(s) regardless of symptoms. After zero cases of candidaemia for two years, there were five cases in elective urology patients within 15 weeks between June – September 2021. This increased incidence of candidaemia amongst these patients prompted multidisciplinary investigation.
Methods
Single centre case series, in a 250-bed hospital which annually performs 2000-2500 elective urology surgeries. Affected patients were elderly with multiple comorbidities. Notably, four of five patients had prior indwelling ureteral stents. All five patients had preoperative bacteriuria requiring antibiotics and one patient had pre-operative candiduria.
Results
Hypotheses including sterilisation failure, surgical instrument contamination, or surgical technique issues were unfounded. We propose that pre-operative duration of antibacterial therapy, particularly in the setting of ureteral stent biofilm, is a significant factor for candiduria. A new prescribing algorithm for urology patients was devised. Antibiotic treatment duration in asymptomatic patients with indwelling urinary tract foreign material was reduced from 14 to 3 days, and from 14 to 7 days in symptomatic patients. Dedicated pharmacist resources were allocated to support this change and pre-operatively manage these patients. These interventions led to zero candidaemia cases over the subsequent 21 months, along with zero post-operative bacterial bloodstream infections.
Conclusions
Prolonged pre-operative antibacterial therapy poses a risk for post-operative candidaemia, especially in patients with ureteral stents. Shortening pre-operative antibiotic courses, coupled with increased pharmacist involvement, effectively reduced candidaemia incidence.
期刊介绍：
The journal aims to be a platform for the publication and dissemination of knowledge in the area of infection and disease causing infection in humans. The journal is quarterly and publishes research, reviews, concise communications, commentary and other articles concerned with infection and disease affecting the health of an individual, organisation or population. The original and important articles in the journal investigate, report or discuss infection prevention and control; clinical, social, epidemiological or public health aspects of infectious disease; policy and planning for the control of infections; zoonoses; and vaccination related to disease in human health. Infection, Disease & Health provides a platform for the publication and dissemination of original knowledge at the nexus of the areas infection, Disease and health in a One Health context. One Health recognizes that the health of people is connected to the health of animals and the environment. One Health encourages and advances the collaborative efforts of multiple disciplines-working locally, nationally, and globally-to achieve the best health for people, animals, and our environment. This approach is fundamental because 6 out of every 10 infectious diseases in humans are zoonotic, or spread from animals. We would be expected to report or discuss infection prevention and control; clinical, social, epidemiological or public health aspects of infectious disease; policy and planning for the control of infections; zoonosis; and vaccination related to disease in human health. The Journal seeks to bring together knowledge from all specialties involved in infection research and clinical practice, and present the best work in this ever-changing field. The audience of the journal includes researchers, clinicians, health workers and public policy professionals concerned with infection, disease and health.
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