1586. Epidemiology and Resource Utilization in Pediatric Invasive Candidiasis
Session: Poster Abstract Session: Mycology - There's a Fungus Among Us: Epidemiology
Friday, October 28, 2016
Room: Poster Hall
  • Pediatric IC IDWeek poster_RH_UPLOAD.pdf (469.5 kB)
  • Background:   This retrospective observational study was conducted to gain insight into epidemiology, treatment, length of stay (LOS) and costs for hospitalized neonate and pediatric patients with invasive candidiasis (IC).

    Methods:  The Cerner Health Facts Database, a multicenter US electronic health record database, was used to assess the clinical and economic impact of pediatric IC in inpatients (2005-2014). Patient encounters were identified by positive blood/cerebrospinal fluid (CSF) cultures for Candida, and encounter characteristics were evaluated. The impact of multiple factors on (log-transformed) LOS and cost were examined in patients with candidemia only (n=191) using multivariable linear regression. Model parameter uncertainty was evaluated with bootstrap analysis.

    Results:  From 2005-2014, 202 patients had a positive culture (blood: n=192; CSF: n=12). The most prevalent species at index culture was C. parapsilosis (n=70, 34.7%), followed by C. albicans (n=66, 32.7%). Mean (SD) age was 5 (5.5) years, with 30 patients (14.9%) <4 months of age. Common 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%). Antifungal exposure included azoles (57.4%), polyenes (28.7%), and echinocandins (35.1%); 20.8% of patients had no record of receiving an antifungal during their index encounter. The mean cost per encounter was $97,392 ($149,253), with a mean LOS of 45.6 (59.5) days and 9.9% mortality at discharge. Results did not differ greatly across Candida species. In regression analysis, ICU exposure, central catheter, sepsis, receipt of an antifungal >48 hours prior to index culture, and age <4 months were significantly associated with increased LOS, while treatment at a non-teaching hospital was associated with reduced LOS (p<0.05). Antifungal use >48 hours before index, alive at discharge, Midwest/west region and ventricular shunt were significantly associated with increased cost (p≤0.05).

    Conclusion:  While limited by small sample size, this analysis confirms the association between neonatal and pediatric candidemia and increased resource utilization. However, given high observed rates of potential under-treatment, an opportunity may exist to improve antifungal therapy in this population.

    Rachel Harrington, BA1, Sylvia Kindermann, MPH2, Qingjiang Hou, MS2, Robert Taylor, PhD2, Nkechi Azie, MD1 and David Horn, MD, FIDSA3, (1)Astellas Pharma Global Development, Inc., Northbrook, IL, (2)Cerner Corporation, Kansas City, MO, (3)David Horn, LLC, Doylestown, PA


    R. Harrington, Astellas: Employee , Salary

    S. Kindermann, Cerner Corporation, Kansas City: Employee , Salary

    Q. Hou, Cerner Corporation, Kansas City: Employee , Salary

    R. Taylor, Cerner Corporation, Kansas City: Employee , Salary

    N. Azie, Astellas Pharma Global Development, Inc: Employee , Salary

    D. Horn, Astellas: Consultant , Consulting fee

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.