- 期刊
Evaluating the Protective Effectiveness of a Comprehensive Care Bundle on the Management of Candidemia: Comprehensive Meta-Analysis and Time Sequential Analysis
摘要
Candidemia has become one of the leading causes of healthcare-associated bloodstream infection, particularly in the intensive care unit. The management of candidemia remains challenging. This study aimed to re-assess the protective effectiveness of a comprehensive care bundle on the management of candidemia and the effects of compliance with each element on the outcomes of patients. Studies (from inception until July 2019) in which a care bundle was created for patients with candidemia were identified, and five eligible studies with 5,808 participants were enrolled for further analysis. The random effects model of the overall odds ratio (OR) revealed a significant reduction in the risk of all-cause mortality as compared with that of the controls (OR: 0.599; 95% confidence interval [CI]: 0.378-0.949; p = 0.025), as well as a reduction in the risk of developing persistent candidemia as compared with the controls (OR: 0.483; 95% CI: 0.245-0.952; p = 0.008). In addition, no single element reached a protective effectiveness to improve the clinical outcome. This meta-analysis demonstrated that the combination of core elements in the care bundle resulted in protective effects, in that the all-cause mortality rate and incidence rate were effectively reduced in patients with persistent candidemia.