Abstract
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.
Acknowledgements
TRANSNET was sponsored by the Centers for Disease Control (CDC), Astellas, Pfizer, Merck, and Schering Plough. Pfizer sponsored additional treatment data collection. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers of Disease Control and Prevention.
Declaration of interest: JWB was sponsored in part by NIH K23AI064613. He is on the advisory board or consulting for Pfizer and Merck. DRA receives research grants from Merck, Astellas and Pfizer and is a consultant for Astellas, Novartis, Merck, Schering Plough. KAM is sponsored in part by NIH K24AI085118 and receives research grants from Merck, Astellas and Pfizer. He is on the advisory board or consulting for Astellas, Basilea, Merck, Pfizer, Schering Plough. CAK receives research grants from Merck and is on the data adjudication Board, Pfizer, and the Data Safety Monitoring Board, Merck. DPK has received research support and honoraria from Schering-Plough, Pfizer, Astella Pharma Inc., Enzon Pharmaceuticals, and Merck and Co., Inc. JII is on the speakers’ bureaux for Astellas, Enzon, Merck, Pfizer, Schering-Plough and is a consultant for Enzon, Sigma Tau. TFP receives research grants from Astellas, Basilea, Merck, Pfizer and Schering-Plough and is on the advisory boards or consulting for Astellas, Basilea, Merck, Pfizer and Toyoma. GML is on the advisory board for Merck and receives research funding from Pfizer, Astellas and Qiagen. PGP receives research support and is an ad hoc advisor for Merck, Pfizer, Astellas, Basilea and T2 Biosystems. The remaining authors have no conflicts of interest for this subject matter. The authors alone are responsible for the content and writing of the paper.
This paper was first published online on Early Online on 7 June 2012.