Candidemia and invasive candidiasis among hospitalized neonates and pediatric patients
| Autor: | Robert J. Taylor, Rachel Harrington, Qingjiang Hou, Sylvia L. Kindermann, David Horn, Nkechi Azie |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
Antifungal medicine.medical_specialty Antifungal Agents medicine.drug_class 030106 microbiology Sepsis 03 medical and health sciences 0302 clinical medicine 030225 pediatrics Internal medicine Epidemiology medicine Humans Candidiasis Invasive Child business.industry Infant Newborn Candidemia Infant General Medicine Invasive candidiasis Length of Stay medicine.disease Infant newborn Surgery Child Preschool Positive culture business |
| Zdroj: | Current Medical Research and Opinion. 33:1803-1812 |
| ISSN: | 1473-4877 0300-7995 2005-2014 |
| DOI: | 10.1080/03007995.2017.1354824 |
| Popis: | To investigate the epidemiology, treatment, length of stay (LOS) and costs for neonatal and pediatric inpatients with invasive candidiasis (IC).The Cerner Health Facts Database was used to assess inpatients (2005-2014) identified by positive blood or cerebrospinal fluid (CSF) Candida cultures. Log-transformed LOS and cost were examined in candidemia-only patients (n = 191) using multivariable linear regression.A total of 202 patients had a positive culture (blood: n = 192; CSF: n = 10; both: n = 2). The most prevalent species were C. parapsilosis (n = 70, 34.7%), and C. albicans (n = 66, 32.7%). Mean (SD) age was 5 (5.5) years; 30 (14.9%) patients were4 months. Comorbidities included sepsis (n = 85, 42.1%), coagulation disorders (n = 57, 28.2%), cancer (n = 64, 31.7%), and low birthweight (n = 26, 12.9%). Antifungals (AFs) included azoles (57.4%), polyenes (28.7%), and echinocandins (35.1%); 20.8% of patients received no AF during their encounter. The mean (SD) cost per encounter was $97,392 ($149,253), with a mean (SD) LOS of 45.6 (59.5) days and 9.9% mortality at discharge. Results were similar across Candida species. In regression analysis, intensive care unit (ICU) exposure, central catheter, sepsis, AF48 hours prior to index culture, and age4 months were associated with increased LOS; treatment at a non-teaching hospital was associated with reduced LOS (p .05). AF use48 hours before index, in-hospital mortality, Midwest region and ventricular shunt were associated with increased cost (p ≤ .05).This analysis confirms the association between pediatric candidemia and increased resource utilization and LOS. Given high observed rates of potential under-treatment, an opportunity may exist to improve AF therapy in this population. |
| Databáze: | OpenAIRE |
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