Candidemia and invasive candidiasis among hospitalized neonates and pediatric patients

Abstract

Objective: To investigate the epidemiology, treatment, length of stay (LOS) and costs for neonatal and pediatric inpatients with invasive candidiasis (IC).

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords:

• Candidemia
• candidiasis
• antifungal
• treatment

Transparency

Declaration of funding

Astellas Pharma Global Development, Inc. provided funding for this project.

Author contributions: R.H., D.L.H. and S.L.K. designed the study. R.J.T. built the analytic file and created the database. Q.H. performed the statistical analyses. R.H., D.L.H. and S.L.K. provided direction and interpreted the study results. S.L.K., R.H., and D.L.H. wrote the manuscript. All authors contributed reviewed/edited the manuscript and agree to be accountable for all aspects of the work.

Declaration of financial/other relationships

S.L.K., Q.H. and R.J.T. have disclosed that they are employed by Cerner Corporation, which was contracted by Astellas Pharma for this project. Cerner Corporation owns and maintains the Health Facts database used in this analysis. R.H. has disclosed that she is an employee of Astellas Pharma Global Development Inc. N.A. has disclosed that she was an employee of Astellas Pharma Global Development Inc. at the time the study was conducted. D.L.H. has disclosed that he is a paid consultant of Astellas Pharma.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

No assistance in the preparation of this article is to be declared.