The epidemiology and attributable outcomes of candidemia in adults and children hospitalized in the United States: A propensity analysis

Theoklis E. Zaoutis, Jesse Argon, Jaclyn Chu, Jesse A. Berlin, Thomas J. Walsh, Chris Feudtner

Research output: Contribution to journalArticle

Abstract

Background. Candida species are the fourth most common cause of bloodstream infection and are the leading cause of invasive fungal infection among hospitalized patients in the United States. However, the frequency and outcomes attributable to the infection are uncertain. This retrospective study set out to estimate the incidence of candidemia in hospitalized adults and children in the United States and to determine attributable mortality, length of hospital stay, and hospital charges related to candidemia. Methods. We used the Nationwide Inpatient Sample 2000 for adult patients and the Kids' Inpatient Database 2000 for pediatric patients. We matched candidemia-exposed and candidemia-unexposed patients by the propensity scores for the probability of candidemia exposure, which were derived from patient characteristics. Attributable outcomes were calculated as the differences in estimates of outcomes between propensity score-matched patients with and without candidemia. Results. In the United States in 2000, candidemia was diagnosed in an estimated 1118 hospital admissions of pediatric patients and 8949 hospital admissions of adult patients, yielding a frequency of 43 cases per 100,000 pediatric admissions (95% confidence interval [CI], 35-52 cases per 100,000 pediatric admissions) and 30 cases per 100,000 adult admissions (95% CI, 26-34 cases per 100,000 adult admissions). In pediatric patients, candidemia was associated with a 10.0% increase in mortality (95% CI, 6.2%-13.8%), a mean 21.1-day increase in length of stay (95% CI, 14.4-27.8 days), and a mean increase in total per-patient hospital charges of $92,266 (95% CI, $65,058-$119,474). In adult patients, candidemia was associated with a 14.5% increase in mortality (95% CI, 12.1%-16.9%), a mean 10.1-day increase in length of stay (95% CI, 8.9-11.3 days), and a mean increase in hospital charges of $39,331 (95% CI, $33,604-$45,602). Conclusion. The impact of candidemia on excess mortality, increased length of stay, and the burden of cost of hospitalization underscores the need for improved means of prevention and treatment of candidemia in adults and children.

Original languageEnglish (US)
Pages (from-to)1232-1239
Number of pages8
JournalClinical Infectious Diseases
Volume41
Issue number9
DOIs
StatePublished - Nov 1 2005
Externally publishedYes

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Candidemia
Hospitalized Child
Epidemiology
Confidence Intervals
Length of Stay
Hospital Charges
Pediatrics
Propensity Score
Mortality
Patient Admission
Inpatients
Pediatric Hospitals
Infection
Candida
Hospitalization
Retrospective Studies

ASJC Scopus subject areas

  • Immunology

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The epidemiology and attributable outcomes of candidemia in adults and children hospitalized in the United States : A propensity analysis. / Zaoutis, Theoklis E.; Argon, Jesse; Chu, Jaclyn; Berlin, Jesse A.; Walsh, Thomas J.; Feudtner, Chris.

In: Clinical Infectious Diseases, Vol. 41, No. 9, 01.11.2005, p. 1232-1239.

Research output: Contribution to journalArticle

Zaoutis, Theoklis E. ; Argon, Jesse ; Chu, Jaclyn ; Berlin, Jesse A. ; Walsh, Thomas J. ; Feudtner, Chris. / The epidemiology and attributable outcomes of candidemia in adults and children hospitalized in the United States : A propensity analysis. In: Clinical Infectious Diseases. 2005 ; Vol. 41, No. 9. pp. 1232-1239.
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abstract = "Background. Candida species are the fourth most common cause of bloodstream infection and are the leading cause of invasive fungal infection among hospitalized patients in the United States. However, the frequency and outcomes attributable to the infection are uncertain. This retrospective study set out to estimate the incidence of candidemia in hospitalized adults and children in the United States and to determine attributable mortality, length of hospital stay, and hospital charges related to candidemia. Methods. We used the Nationwide Inpatient Sample 2000 for adult patients and the Kids' Inpatient Database 2000 for pediatric patients. We matched candidemia-exposed and candidemia-unexposed patients by the propensity scores for the probability of candidemia exposure, which were derived from patient characteristics. Attributable outcomes were calculated as the differences in estimates of outcomes between propensity score-matched patients with and without candidemia. Results. In the United States in 2000, candidemia was diagnosed in an estimated 1118 hospital admissions of pediatric patients and 8949 hospital admissions of adult patients, yielding a frequency of 43 cases per 100,000 pediatric admissions (95{\%} confidence interval [CI], 35-52 cases per 100,000 pediatric admissions) and 30 cases per 100,000 adult admissions (95{\%} CI, 26-34 cases per 100,000 adult admissions). In pediatric patients, candidemia was associated with a 10.0{\%} increase in mortality (95{\%} CI, 6.2{\%}-13.8{\%}), a mean 21.1-day increase in length of stay (95{\%} CI, 14.4-27.8 days), and a mean increase in total per-patient hospital charges of $92,266 (95{\%} CI, $65,058-$119,474). In adult patients, candidemia was associated with a 14.5{\%} increase in mortality (95{\%} CI, 12.1{\%}-16.9{\%}), a mean 10.1-day increase in length of stay (95{\%} CI, 8.9-11.3 days), and a mean increase in hospital charges of $39,331 (95{\%} CI, $33,604-$45,602). Conclusion. The impact of candidemia on excess mortality, increased length of stay, and the burden of cost of hospitalization underscores the need for improved means of prevention and treatment of candidemia in adults and children.",
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T1 - The epidemiology and attributable outcomes of candidemia in adults and children hospitalized in the United States

T2 - A propensity analysis

AU - Zaoutis, Theoklis E.

AU - Argon, Jesse

AU - Chu, Jaclyn

AU - Berlin, Jesse A.

AU - Walsh, Thomas J.

AU - Feudtner, Chris

PY - 2005/11/1

Y1 - 2005/11/1

N2 - Background. Candida species are the fourth most common cause of bloodstream infection and are the leading cause of invasive fungal infection among hospitalized patients in the United States. However, the frequency and outcomes attributable to the infection are uncertain. This retrospective study set out to estimate the incidence of candidemia in hospitalized adults and children in the United States and to determine attributable mortality, length of hospital stay, and hospital charges related to candidemia. Methods. We used the Nationwide Inpatient Sample 2000 for adult patients and the Kids' Inpatient Database 2000 for pediatric patients. We matched candidemia-exposed and candidemia-unexposed patients by the propensity scores for the probability of candidemia exposure, which were derived from patient characteristics. Attributable outcomes were calculated as the differences in estimates of outcomes between propensity score-matched patients with and without candidemia. Results. In the United States in 2000, candidemia was diagnosed in an estimated 1118 hospital admissions of pediatric patients and 8949 hospital admissions of adult patients, yielding a frequency of 43 cases per 100,000 pediatric admissions (95% confidence interval [CI], 35-52 cases per 100,000 pediatric admissions) and 30 cases per 100,000 adult admissions (95% CI, 26-34 cases per 100,000 adult admissions). In pediatric patients, candidemia was associated with a 10.0% increase in mortality (95% CI, 6.2%-13.8%), a mean 21.1-day increase in length of stay (95% CI, 14.4-27.8 days), and a mean increase in total per-patient hospital charges of $92,266 (95% CI, $65,058-$119,474). In adult patients, candidemia was associated with a 14.5% increase in mortality (95% CI, 12.1%-16.9%), a mean 10.1-day increase in length of stay (95% CI, 8.9-11.3 days), and a mean increase in hospital charges of $39,331 (95% CI, $33,604-$45,602). Conclusion. The impact of candidemia on excess mortality, increased length of stay, and the burden of cost of hospitalization underscores the need for improved means of prevention and treatment of candidemia in adults and children.

AB - Background. Candida species are the fourth most common cause of bloodstream infection and are the leading cause of invasive fungal infection among hospitalized patients in the United States. However, the frequency and outcomes attributable to the infection are uncertain. This retrospective study set out to estimate the incidence of candidemia in hospitalized adults and children in the United States and to determine attributable mortality, length of hospital stay, and hospital charges related to candidemia. Methods. We used the Nationwide Inpatient Sample 2000 for adult patients and the Kids' Inpatient Database 2000 for pediatric patients. We matched candidemia-exposed and candidemia-unexposed patients by the propensity scores for the probability of candidemia exposure, which were derived from patient characteristics. Attributable outcomes were calculated as the differences in estimates of outcomes between propensity score-matched patients with and without candidemia. Results. In the United States in 2000, candidemia was diagnosed in an estimated 1118 hospital admissions of pediatric patients and 8949 hospital admissions of adult patients, yielding a frequency of 43 cases per 100,000 pediatric admissions (95% confidence interval [CI], 35-52 cases per 100,000 pediatric admissions) and 30 cases per 100,000 adult admissions (95% CI, 26-34 cases per 100,000 adult admissions). In pediatric patients, candidemia was associated with a 10.0% increase in mortality (95% CI, 6.2%-13.8%), a mean 21.1-day increase in length of stay (95% CI, 14.4-27.8 days), and a mean increase in total per-patient hospital charges of $92,266 (95% CI, $65,058-$119,474). In adult patients, candidemia was associated with a 14.5% increase in mortality (95% CI, 12.1%-16.9%), a mean 10.1-day increase in length of stay (95% CI, 8.9-11.3 days), and a mean increase in hospital charges of $39,331 (95% CI, $33,604-$45,602). Conclusion. The impact of candidemia on excess mortality, increased length of stay, and the burden of cost of hospitalization underscores the need for improved means of prevention and treatment of candidemia in adults and children.

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