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1 November 2005

Volume 41, Number 9
Clinical Infectious Diseases 2005;41:1232–1239
© 2005 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2005/4109-0003$15.00
DOI: 10.1086/496922
MAJOR ARTICLE

The Epidemiology and Attributable Outcomes of Candidemia in Adults and Children Hospitalized in the United States: A Propensity Analysis

Theoklis E. Zaoutis,1,2,5

Jesse Argon,1

Jaclyn Chu,1,2

Jesse A. Berlin,4,a

Thomas J. Walsh,6 and

Chris Feudtner1,3

1Pediatric Generalists Research Group, Division of General Pediatrics, and 2Division of Infectious Diseases, The Children’s Hospital of Philadelphia, 3Leonard Davis Institute of Health Economics, University of Pennsylvania, 4Department of Biostatistics and the Center for Clinical Epidemiology and Biostatistics, and 5Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; and 6Immunocompromised Host Section, Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland

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.

Received 28 February 2005; accepted 8 June 2005; electronically published 20 September 2005.

  • (See the editorial commentary by Fridkin on pages 1240–1)

Reprints or correspondence: Dr. Theoklis E. Zaoutis, Div. of Infectious Diseases, Children’s Hospital of Philadelphia, 34th and Civic Center Blvd., Philadelphia, PA 19104 ().

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  • Present affiliation: Johnson and Johnson Pharmaceutical Research and Development, Titusville, New Jersey.

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