K-1385. Bloodstream Infection with C. Albicans and Non-albicans Associated with High Economic and Mortality Burden Among Children and Adults
Session: Poster Session: Candida Infections, Risk Factors and Treatment
Sunday, October 26, 2008: 12:00 AM
Room: Hall C
Background: Candida bloodstream infections (BSI) are associated with substantial morbidity, mortality and costs. We evaluated clinical and economic outcomes associated with candidemia, focusing on differences between C. albicans and non-albicans species, and between children and adults. Methods: The study included all patients hospitalized at Duke University Medical Center from February 1996 to July 2007 with a blood culture positive for Candida. Cost data were available for patients hospitalized since December 2002. Total costs and length of stay (LOS) represent all costs and inpatient days incurred from the date of the first positive blood culture. We used generalized linear models to compare costs, negative binomial models to compare LOS, and chi-square tests to compare inpatient mortality. Results: 1134 patients were identified with Candida BSI (45% albicans, 22% <18 years). Cost data were available for 446 (39%). Children had higher costs compared to adults ($137,024 vs. $56,083, p<0.0001), longer LOS (42.5 vs. 20.7 days, p<0.0001), and lower mortality (31% vs. 44%, p=0.0004). Among children, there were no significant differences between those with C. albicans and non-albicans in terms of costs ($120,991 vs. $151,824, p=0.26), LOS (46 vs. 40 days, p=0.29), or mortality (27% vs. 34%, p=0.22). Among adults, those with C. albicans versus non-albicans had lower costs ($46,851 vs. $62,357, p=0.009), shorter LOS (19 vs. 22 days, p=0.008), but comparable mortality (43% vs. 44%, p=0.69). Conclusions: Candida BSI are associated with high inpatient costs, extended LOS, and high mortality. Adults infected with non-albicans incurred higher costs and longer stays than adults with C. albicans. Future studies that estimate costs and LOS attributable to Candida BSI are needed to study the value of strategies to reduce the incidence of candidemia.
Cassandra Moran1, Chelsea Grussemeyer2, Danny Benjamin3, James Spalding, PharmD4, Joelle Friedman, MPA5, Shelby Reed, PhD5 and  C. A. Grussemeyer, None., (1)Duke University Medical Center, (2)Duke Clinical Research Institute, Durham, NC, (3)Duke Clinical Research Institute, (4)Astellas Pharma US, Inc., Deerfield, IL, (5)DCRI, Durham, NC