Abstract
Non-endemic, invasive fungal infections (IFI) remain a major cause of morbidity and mortality but their healthcare epidemiologic patterns require further elucidation. The 1996–2006 records in the National Hospital Discharge Survey (NHDS) of a hospitalized sub-cohort of HIV, hematologic malignancy, and transplant patients were analyzed. The objective was to determine independent predictors of non-endemic IFI, apart from other known predisposing host factors. Population-weighted, univariate analyses identified potential variables to include in multivariate models. Risk ratios for IFI using logistic regression and calculated incidence rate ratios (IRR) for IFI-associated mortality using a discrete, proportional hazards model were estimated. A total of 372 IFI hospital discharges, with a case-fatality proportion of 11.7% were identified. There was a significant trend toward increasing IFI hospitalizations (86.2%) in smaller hospitals (< 500 beds). Most IFIs occurred during the spring (37.6%, P = 0.01) and in the Midwest and South (41%) sections of the US, and lasted more than 7 days (61.7%, P < 0.0001). However, multivariable analysis revealed that the risk for IFI hospitalization was greatest during the autumn in the Midwest (RR=6.25 [1.57–24.9], P = 0.009) and in the Northeast (RR=8.14 [2.03–32.6], P = 0.003). Transfer from another healthcare facility conferred over a 3-fold increase risk (RR = 3.38 [2.30–4.97]) whereas a clinician referral reduced the risk by 36% (RR=0.64 [0.44–0.88]). The IFI-related mortality rate was least for the young, regardless of area and season (IRR0-14years = 0.155 [0.044–0.550]). Maintaining a steady rate over the past decade, non-endemic IFI hospitalizations exhibit a significant differential distribution in time and space. Prevention efforts that incorporate these trends may lessen IFI healthcare burden.
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Acknowledgements
Thanks to E. Andres Houseman, Sc.D. from the Catalyst Program – Assistant Professor of Community Health (Research) Center for Environmental Health and Technology, the Warren Alpert Medical School of Brown University, and Adjunct Assistant Professor of Biostatistics Department of Biostatistics, Harvard School of Public Health – for his statistical advice and corroboration.
Financial support: None
Declaration of interest: The author has no conflicts of interest to declare. The author alone is responsible for the content and writing of this paper.
This paper was first published online on Early Online on 1 February 2010.