Candidemia treatment is improved by infectious disease consultation: A population-based cohort study
Bibliographic record
Abstract
Introduction: Candidemia is a common bloodstream infection with morbidity and mortality. Both the European Society of Clinical Microbiology and Infectious Diseases and Infectious Diseases Society of America have evidence-based recommendations for its management. While infectious diseases consultation (IDC) reduced mortality, effects on guideline concordance remain unclear. Methods: We conducted a multicentre retrospective cohort study (2010–2018) in Canada to characterize the role of IDC in attaining evidence-based recommendations for adults with candidemia. Such recommendations include follow-up blood cultures to document blood clearance, prompt antifungal initiation and selection, source control, treatment duration determination, and ancillary investigations. We measured associations between IDC and adherence to evidence-based recommendations. Results: Patients with candidemia who received IDC were more likely not to be left without antifungal therapy (26% versus 4.8%). Echocardiograms were more common in noncritically ill patients with IDC (64% versus 44%; P < 0.01) and in all critically ill patients, irrespective of IDC status (75% versus 63%; P = 0.08). In patients with uncomplicated candidemia, treatment duration ≥14 days was similar with or without IDC (78% versus 70%; P = 0.15). Patients with complicated candidemia and IDC were more likely treated for ≥42 days (an appropriate duration; 100% versus 47%; P = 0.06). Fluconazole (transition therapy) was not affected by IDC for critically ill (41% and 29%; P = 0.34) or noncritically ill patients (34% versus 24%; P = 0.51). Mortality rates at 30 and 60 days after candidemia diagnosis were lower in patients receiving IDC ( P < 0.05). Conclusions: Best practice guidelines were issued for patients with candidemia; adherence varied, but involvement of an infectious disease physician increased implementation and was associated with considerably decreased mortality.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".