Impact of First-Line Antifungal Agents on the Outcomes and Costs of Candidemia

Ha, Young Eun; Peck, Kyong Ran; Joo, Eun Jeong; Kim, Shin‐Woo; Jung, Sook In; Chang, Hyun Ha; Park, Kyong Hwa; Han, Sang Hoon

doi:10.1128/aac.06258-11

Cited by 26 publications

(17 citation statements)

References 24 publications

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“…Our results confirm recent studies’ results, in which a relationship between delaying the initiation of antifungal therapy and mortality was demonstrated [24,49]. For example, Bassetti et al [49] showed that the initiation of antifungal treatment 48 h after having the first positive blood culture report was an independent determinant of hospital mortality.…”

Section: Discussionsupporting

confidence: 91%

Epidemiology, species distribution and outcome of nosocomial Candida spp.bloodstream infection in Shanghai

et al. 2014

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BackgroundYeasts, mostly Candida, are important causes of bloodstream infections (BSI), responsible for significant mortality and morbidity among hospitalized patients. The epidemiology and species distribution vary from different regions. The goals of this study were to report the current epidemiology of Candida BSI in a Shanghai Teaching Hospital and estimate the impact of appropriate antifungal therapy on the outcome.MethodsFrom January 2008 to December 2012, all consecutive patients who developed Candida BSI at Ruijin University Hospital were enrolled. Underlying diseases, clinical severity, species distribution, antifungal therapy and its impact on the outcome were analyzed.ResultsA total of 121 episodes of Candida BSI were identified, with an incidence of 0.32 episodes/1,000 admissions (0.21 in 2008 and 0.42 in 2012) The proportion of candidemia caused by non-albicans species (62.8%), including C. parapsilosis (19.8%), C. tropicalis (14.9%), C. glabrata (7.4%), C. guilliermondii (5.8%), C. sake (5.0%) was higher than that of candidemia caused by C. albicans (37.2%). The overall crude 28-day mortality was 28.1% and significantly reduced with appropriate empiric antifungal therapy administered within 5 days (P = 0.006). Advanced age (OR 1.04; P = 0.014), neutropenia < 500/mm3 (OR 17.44; P < 0.001) were independent risk factors for 28-day mortality, while appropriate empiric antifungal therapy (OR 0.369; P = 0.035) was protective against 28-day mortality.ConclusionThe epidemiology of candidemia in Shanghai differed from that observed in Western countries. Appropriate empiric antifungal therapy influenced the short-term survival.

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Section: Discussionsupporting

confidence: 91%

Epidemiology, species distribution and outcome of nosocomial Candida spp.bloodstream infection in Shanghai

et al. 2014

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“…In our study, ICU stay, central venous catheterization, mechanical ventilation, length of hospitalization, number of comorbidities, severe sepsis and septic shock were identified as predictors of mortality in patients with candidemia. These results are in agreement with previously published studies that reported risk factors for mortality in patients with candidemia [4,16,20,28,[31][32][33].…”

Section: Discussionsupporting

confidence: 83%

Characteristics and clinical outcomes of patients with Candida bloodstream infections in a tertiary care hospital in Jordan

Ababneh

Abu-Bdair

Mhaidat

et al. 2017

J Infect Dev Ctries

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Introduction: Candida species are important causes of bloodstream infections, accounting for significant morbidity and mortality in hospitalized patients. Methodology: A retrospective observational study was conducted in an academic tertiary hospital of Jordan. The medical records of patients hospitalized over a ten-year period. were reviewed and patients with candidemia were identified. Data analysis included the infecting Candida species, resistance to antifungals, and risk factors associated with mortality. Results: A total of 158 cases of candidemia were identified, with an overall incidence rate of 0.48 episodes/1,000 admissions. The proportion of candidemia caused by Candida albicans (44.3%) was higher than that of candidemia caused by non-albicans Candida species (42.4%). Exposure to antibiotic therapy before hospitalization was the only independent factor associated with non-albicans Candida infection (OR 2.454; p = 0.033). The overall crude 30-day mortality was 38.7%. Central venous catheterization (OR 0.255; p = 0.026), mechanical ventilation (OR 0.162; p = 0.003), severe sepsis and septic shock (OR = 0.073; p = 0.008), admission to intensive care unit (OR 0.78; p = 0.001), C. albicans (OR 0.235; p = 0.018), length of stay (OR 1.057; p = 0.001), number of comorbidities (OR 0.580; p = 0.008) were independent risk factors for 30-day mortality. Conclusion: This study identified several risk factors associated with blood stream infections caused by Candida over 10-years period. Continuous surveillance programs to monitor such types of infection are of great value to antimicrobial stewardship programs.

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“…Others showed that inappropriate antifungal treatment prolonged LOS by 8 days, and contributed an extra $13 000 to total costs and increased mortality (28.8% vs 0%) . Therefore choosing an appropriate first‐line antifungal agent is crucial for better outcomes, reduced LOS and lower hospital cost of managing candidiasis …”

Section: Discussionmentioning

confidence: 99%

Clinical factors affecting costs in patients receiving systemic antifungal therapy in intensive care units in Greece: Results from the ESTIMATOR study

Armaganidis

Nanas

Antoniadou

et al. 2017

Mycoses

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Summary Invasive fungal infections are common in intensive care units (ICUs) but there is a great variability in factors affecting costs of different antifungal treatment strategies in clinical practice. To determine factors affecting treatment cost in adult ICU patients with or without documented invasive fungal infection receiving systemic antifungal therapy (SAT) we have performed a prospective, multicentre, observational study enrolling patients receiving SAT in participating ICUs in Greece. During the study period, 155 patients received SAT at 14 participating ICUs: 37 (23.9%) for proven fungal infection before treatment began, 10 (6.5%) prophylactically, 77 (49.7%) empirically and 31 (20.0%) pre‐emptively; 66 patients receiving early SAT (55.9%) were subsequently confirmed to have proven infection with Candida spp. (eight while on treatment). The most frequently used antifungal drugs were echinocandins (89/155; 57.4%), fluconazole (31/155; 20%) and itraconazole (20/155; 12.9%). Mean total cost per patient by SAT strategy was €20 458 (proven), €15 054 (prophylaxis), €23 594 (empiric) and €22 184 (pre‐emptive). Factors associated with significantly increased cost were initial treatment failure, length of stay (LOS) in ICU before starting SAT (i.e. from admission until treatment start), fever and proven candidaemia (all P≤.05). Conclusion: Early administration of antifungal drugs was not a substantial component of total hospital costs. However, there was a significant adverse impact on costs with increasing LOS in febrile patients in ICU for whom diagnosis of fungaemia was delayed before starting SAT, and with initial treatment failure. Awareness of potential candidaemia and initiation of pre‐emptive or empirical strategy as early appropriate treatment may improve ICU patient outcomes while reducing direct medical costs.

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Impact of First-Line Antifungal Agents on the Outcomes and Costs of Candidemia

Cited by 26 publications

References 24 publications

Epidemiology, species distribution and outcome of nosocomial Candida spp.bloodstream infection in Shanghai

Epidemiology, species distribution and outcome of nosocomial Candida spp.bloodstream infection in Shanghai

Characteristics and clinical outcomes of patients with Candida bloodstream infections in a tertiary care hospital in Jordan

Clinical factors affecting costs in patients receiving systemic antifungal therapy in intensive care units in Greece: Results from the ESTIMATOR study

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