The epidemiology and attributable outcomes of candidemia in adults and children hospitalized in the United States: A propensity analysis
The epidemiology and attributable outcomes of candidemia in adults and children hospitalized in the United States: A propensity analysis
复制标题
DOI：
10.1086/496922
复制
发表时间：
2005-11-01
影响因子：
11.8
通讯作者：
Feudtner, C
中科院分区：
文献类型：
--
作者：
Zaoutis, TE;Argon, J;Feudtner, C
背景念珠菌属是血流感染的第四大常见原因，并且是美国住院患者中侵袭性真菌感染的主要原因。然而，感染的频率和结果尚不确定。本回顾性研究旨在评估美国住院成人和儿童念珠菌血症的发病率，并确定与念珠菌相关的死亡率、住院时间和住院费用。我们使用全国住院病人样本2000为成人患者和儿童住院病人数据库2000为儿科患者。我们根据患者特征得出的念珠菌血症暴露概率的倾向评分，将念珠菌暴露患者和念珠菌未暴露患者进行匹配。可归因的结果被计算为倾向评分匹配的有和没有念珠菌病的患者之间的结果估计的差异。2000年，在美国，估计有1118例儿科住院患者和8949例成人住院患者被诊断为念珠菌血症，每10万例儿科住院患者中有43例发生（95%置信区间[CI]，每100，000例儿科住院患者中有35-52例）和每100，000例成人住院患者中有30例（95% CI，每100，000例成人住院患者中有26-34例）。在儿科患者中，念珠菌血症与死亡率增加10.0%（95% CI，6.2%-13.8%），住院时间平均增加21.1天（95% CI，14.4-27.8天），每位患者的总住院费用平均增加92，266美元（95% CI，65，058 - 119，474美元）相关。在成人患者中，念珠菌血症与死亡率增加14.5%（95%CI，12.1%-16.9%），住院时间平均增加10.1天（95%CI，8.9-11.3天），住院费用平均增加39，331美元（95%CI，33，604 - 45，602美元）相关。念珠菌血症对死亡率过高、住院时间延长和住院费用负担的影响强调了需要改进成人和儿童念珠菌血症的预防和治疗手段。
Background. Candida species are the fourth most common cause of bloodstream infection and are the leading cause of invasive fungal infection among hospitalized patients in the United States. However, the frequency and outcomes attributable to the infection are uncertain. This retrospective study set out to estimate the incidence of candidemia in hospitalized adults and children in the United States and to determine attributable mortality, length of hospital stay, and hospital charges related to candidemia.Methods. We used the Nationwide Inpatient Sample 2000 for adult patients and the Kids' Inpatient Database 2000 for pediatric patients. We matched candidemia-exposed and candidemia-unexposed patients by the propensity scores for the probability of candidemia exposure, which were derived from patient characteristics. Attributable outcomes were calculated as the differences in estimates of outcomes between propensity score-matched patients with and without candidemia.Results. In the United States in 2000, candidemia was diagnosed in an estimated 1118 hospital admissions of pediatric patients and 8949 hospital admissions of adult patients, yielding a frequency of 43 cases per 100,000 pediatric admissions (95% confidence interval [CI], 35-52 cases per 100,000 pediatric admissions) and 30 cases per 100,000 adult admissions (95% CI, 26-34 cases per 100,000 adult admissions). In pediatric patients, candidemia was associated with a 10.0% increase in mortality (95% CI, 6.2%-13.8%), a mean 21.1-day increase in length of stay (95% CI, 14.4-27.8 days), and a mean increase in total per-patient hospital charges of $92,266 (95% CI, $65,058 -$119,474). In adult patients, candidemia was associated with a 14.5% increase in mortality (95% CI, 12.1%-16.9%), a mean 10.1-day increase in length of stay (95% CI, 8.9-11.3 days), and a mean increase in hospital charges of $39,331 (95% CI, $33,604-$45,602).Conclusion. The impact of candidemia on excess mortality, increased length of stay, and the burden of cost of hospitalization underscores the need for improved means of prevention and treatment of candidemia in adults and children.