Department of Medicine, University of Alabama at Birmingham and Birmingham VA Medical Center, Birmingham, Alabama 35294-0006, USA.
Med Mycol. 2013 Feb;51(2):128-35. doi: 10.3109/13693786.2012.690108. Epub 2012 Jun 11.
The impact of antifungal therapy on economic outcomes in patients with invasive aspergillosis (IA) needs further exploration. The purpose of this study was to describe antifungal therapy and factors associated with hospital length of stay (LOS) in transplant patients with IA. Patients were enrolled from March 2001 to October 2005 and IA cases identified through March 2006 from a sub-group of patients in the Transplant Associated Infection Surveillance Network (TRANSNET). Factors associated with hospital LOS were determined by logistic regression analysis. Of 361 patients, the mean age was 49 years, 60.7% were male, and 63% were hematopoietic stem cell transplantation (HSCT) recipients. Primary monotherapy was used in 233 (64.5%) patients, of which voriconazole (93/233, 39.9%) was most commonly used antifungal. Primary combination therapy was used in 128 (35.4%) of 361 patients, with voriconazole plus caspofungin (81/361, 22.4%) the most frequently employed. Mean duration of therapy was 115 days (HSCT 109.7; solid organ transplant [SOT] 125.3). Mean hospital LOS was 35.3 days (HSCT 38.7; SOT 29.7). Regression analysis identified disseminated IA, neutropenia, malnutrition and length of ICU stay as factors associated with increased hospital LOS. Initial voriconazole use was associated with decreased LOS. Further investigation on impact of antifungal therapy on economic outcomes is needed.
抗真菌治疗对侵袭性曲霉病（IA）患者的经济结果的影响需要进一步探讨。本研究的目的是描述抗真菌治疗和与 IA 移植患者住院时间（LOS）相关的因素。患者于 2001 年 3 月至 2005 年 10 月入选，并于 2006 年 3 月从移植相关感染监测网络（TRANSNET）的一个亚组患者中确定 IA 病例。通过逻辑回归分析确定与住院 LOS 相关的因素。在 361 例患者中，平均年龄为 49 岁，60.7%为男性，63%为造血干细胞移植（HSCT）受者。233 例（64.5%）患者采用单药治疗，其中伏立康唑（93/233，39.9%）是最常用的抗真菌药物。361 例患者中有 128 例（35.4%）采用联合治疗，其中伏立康唑联合卡泊芬净（81/361，22.4%）最常用。治疗的平均持续时间为 115 天（HSCT 109.7；实体器官移植[SOT]125.3）。平均住院 LOS 为 35.3 天（HSCT 38.7；SOT 29.7）。回归分析确定播散性 IA、中性粒细胞减少、营养不良和 ICU 住院时间是与 LOS 增加相关的因素。初始使用伏立康唑与 LOS 减少相关。需要进一步研究抗真菌治疗对经济结果的影响。
