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.
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
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