Development of a Surveillance System for Fungemia to Assist in Rapid Diagnosis and Treatment to Reduce the Mortality Rate in Nakhon Phanom Hospital
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Abstract
BACKGROUND: Fungemia is a severe infection associated with high mortality. Blood fungal cultures require several days to yield definitive results, leading to delays in diagnosis and treatment. Empirical antifungal therapy is therefore essential in patients with suspected fungemia before culture confirmation.
OBJECTIVES: This study compared mortality rates among patients with fungemia before and after the implementation of a surveillance system. Mortality was the primary outcome, while length of hospital stays, medical costs, and treatment complexity were the secondary outcomes.
METHODS: A retrospective cohort study was conducted among hospitalized patients with laboratory-confirmed fungemia at Nakhon Phanom Hospital between January 1, 2017, and December 31, 2024. An integrated surveillance system incorporating laboratory-based alerts, LINE notifications, and ward-based communication was implemented to streamline clinical workflows and facilitate the timely initiation of empirical antifungal therapy within 24 hours after preliminary blood culture results indicated yeast or molds.
RESULTS: A total of 108 patients were included in the analysis, comprising 74 patients in the pre-implementation control period (2017–2022) and 34 patients in the post-implementation intervention period (2023–2024). The intervention group had a significantly lower mortality rate than the control group (38.2% vs. 74.3%; p<0.001). Implementation of the surveillance system was associated with a substantial reduction in mortality, with a hazard ratio of 0.26 (95% CI, 0.13–0.50), corresponding to a 74% reduction in the risk of death.
CONCLUSIONS: Implementation of an integrated surveillance system was associated with reduced mortality in patients with fungemia by enabling earlier detection and timely empirical antifungal therapy. Hospital stay lengths and costs increased, but improved survival highlighted the clinical value of this system-level intervention.
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