Harrington Rachel, Kindermann Sylvia L, Hou Qingjiang, Taylor Robert J, Azie Nkechi, Horn David L
a At time of study Astellas Pharma Global Development Inc. , Northbrook , IL , USA.
b Cerner Corporation , Culver City , CA , USA.
Curr Med Res Opin. 2017 Oct;33(10):1803-1812. doi: 10.1080/03007995.2017.1354824. Epub 2017 Aug 22.
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 were <4 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, AF >48 hours prior to index culture, and age <4 months were associated with increased LOS; treatment at a non-teaching hospital was associated with reduced LOS (p < .05). AF use >48 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.
调查侵袭性念珠菌病（IC）新生儿和儿科住院患者的流行病学、治疗、住院时间（LOS）及费用。
利用Cerner健康事实数据库评估2005 - 2014年血或脑脊液（CSF）念珠菌培养阳性的住院患者。使用多变量线性回归分析仅念珠菌血症患者（n = 191）经对数转换后的住院时间和费用。
共有202例患者培养结果呈阳性（血培养阳性：n = 192；脑脊液培养阳性：n = 10；两者均阳性：n = 2）。最常见的菌种是近平滑念珠菌（n = 70，34.7%）和白色念珠菌（n = 66，32.7%）。平均（标准差）年龄为5（5.5）岁；30例（14.9%）患者年龄小于4个月。合并症包括败血症（n = 85，42.1%）、凝血障碍（n = 57，28.2%）、癌症（n = 64，31.7%）和低出生体重（n = 26，12.9%）。抗真菌药物（AFs）包括唑类（57.4%）、多烯类（28.7%）和棘白菌素类（35.1%）；20.8%的患者在住院期间未接受抗真菌药物治疗。每次住院的平均（标准差）费用为97,392美元（149,253美元），平均（标准差）住院时间为45.6（59.5）天和出院时死亡率为9.9%。不同念珠菌种的结果相似。在回归分析中，入住重症监护病房（ICU）、中心静脉导管、败血症、在首次培养前48小时以上使用抗真菌药物以及年龄小于4个月与住院时间延长有关；在非教学医院接受治疗与住院时间缩短有关（p < 0.05）。在首次培养前48小时以上使用抗真菌药物、院内死亡率、中西部地区和脑室分流与费用增加有关（p≤0.05）。
该分析证实了儿科念珠菌血症与资源利用增加和住院时间延长之间的关联。鉴于观察到潜在治疗不足的高发生率，可能有机会改善该人群的抗真菌治疗。
