• Yoshio Takesue, Takashi Ueda, Hiroshige Mikamo, Shigeto Oda, Shunji Takakura, Yuko Kitagawa, Shigeru Kohno, and ACTIONs Project.
• ACTIONs Project Committee of Mycoses Forum, Nittochi Toranomon Building, 1-10-5 Toranomon, Minato-ku, Tokyo, 105-8320, Japan Department of Infection Prevention and Control, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan takesuey@hyo-med.ac.jp.
• J. Antimicrob. Chemother. 2015 Feb 1; 70 (2): 587-93.

ObjectivesThe Mycoses Forum in Japan has developed management bundles for candidaemia to incorporate into bedside practice. The aim of this study was to investigate nationwide compliance with the bundles and their impact on clinical outcomes.MethodsNon-neutropenic patients treated with antifungals for candidaemia were surveyed. Bundles consist of nine items to complete. Data were sent to the central office between July 2011 and April 2012.ResultsSix hundred and eight patients were analysed. The compliance rate for achieving all elements was 6.9%, and it increased to 21.4% when compliance was analysed by the bundle except for oral switch. There was a significant difference in clinical success between patients with and without compliance [92.9% versus 75.8% (P=0.011)]. Compliance with the bundles, however, failed to be an independent factor associated with favourable outcomes. When step-down oral therapy was excluded from the elements of compliance, compliance with the bundles was revealed to be an independent predictor of clinical success (OR 4.42, 95% CI 2.05-9.52) and mortality (OR 0.27, 95% CI 0.13-0.57). Independent individual elements contributing to clinical success were removal of central venous catheters within 24 h, assessment of clinical efficacy on the third to the fifth day and at least 2 weeks of therapy after clearance of candidaemia.ConclusionsCompliance with the bundles for candidaemia had a beneficial effect on clinical outcomes. Promotion of the bundles approach may have the potential to narrow the gap between clinical evidence and bedside practice.© The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.

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