ArticleJournal of pharmaceutical health care and sciences2026
Effect of polymerase chain reaction-based antifungal stewardship on candidemia management in small- and medium-sized hospitals.
Article in Journal of pharmaceutical health care and sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCandidemia has high mortality and requires early antifungal stewardship (AFS). Management by non-infectious disease specialists has been associated with worse outcomes, particularly in small- and medium-sized hospitals where infectious disease expertise is often limited. Rapid diagnostic tools such as polymerase chain reaction (PCR) may facilitate earlier stewardship support; however, their clinical impact in these settings remains unclear. This study aimed to evaluate the effect of PCR-based AFS on candidemia management in small- and medium-sized hospitals.
methodsWe compared clinical data before and after the implementation of a PCR-based assay in patients aged ≥ 18 years with Candida species detected in blood cultures at Sapporo Tokushukai Hospital between June 2018 and May 2024 (n = 71 after exclusion). The primary endpoint was 30-day mortality rate. We also assessed the following secondary endpoints: rate of appropriate initial antifungal therapy, removal of central venous catheters (CVCs) within 24 h of diagnosis, prolonged antifungal therapy for ≥ 14 d after blood culture clearance, and time to antifungal therapy initiation.
resultsNo significant difference in 30-day mortality rate was observed between the pre-PCR and post-PCR groups (36.1% vs. 34.3%). Similarly, no significant differences were observed in rate of appropriate initial antifungal therapy, removal of CVCs within 24 h of diagnosis, prolonged antifungal therapy for ≥ 14 d after blood culture clearance, or time to therapy initiation. However, the proportion of physicians less familiar with candidemia care was significantly higher in the post-PCR group than in the pre-PCR group (68.6% vs. 36.1%, P = 0.01).
conclusionsPCR-based AFS might have allowed the quality of candidemia management and patient outcomes to be maintained, even in small- and medium-sized hospitals with a high proportion of physicians less familiar with candidemia care.
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