Mortality, length of hospitalization, and costs associated with invasive fungal infections in high-risk patients

Menzin, Joseph; Meyers, Juliana; Friedman, Mark; Perfect, John R.; Langston, Amelia; Danna, Robert P.; Papadopoulos, George

doi:10.2146/ajhp080325

Cited by 136 publications

(123 citation statements)

References 19 publications

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“…[3][4][5] Candidiasis prolongs both intensive care unit (ICU) and hospital stays and candidemia can increase hospital cost by $40,000 per survivor. 6,7 Nonetheless, in a nationwide study the crude mortality of candidemia in the ICU was 47%. 1 Even though candidiasis has been well studied in other critically ill patient groups such as trauma patients as well as in certain high-risk groups, such as patients with neutropenia, bone marrow transplant recipients or HIV-infected individuals, literature examining specific risk factors for candidiasis among non-trauma emergency surgery patients is lacking.…”

Section: Introductionmentioning

confidence: 99%

Candidainfection and colonization among non-trauma emergency surgery patients

Kourkoumpetis

Manolakaki²,

Velmahos³

et al. 2010

Virulence

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IntroductionCandida is a fungus, which accounts for nearly 96% of all opportunistic mycoses and is the fourth most common bloodstream pathogen in North American and seventh in European hospitals. 1,2 Among critically ill patients, candidiasis is associated with overall severity of illness, increased rate of invasive interventions, use of broadspectrum antibiotics and parenteral nutrition, which are all unavoidable among critically ill patients.3-5 Candidiasis prolongs both intensive care unit (ICU) and hospital stays and candidemia can increase hospital cost by $40,000 per survivor.6,7 Nonetheless, in a nationwide study the crude mortality of candidemia in the ICU was 47%. Even though candidiasis has been well studied in other critically ill patient groups such as trauma patients as well as in certain high-risk groups, such as patients with neutropenia, bone marrow transplant recipients or HIV-infected individuals, literature examining specific risk factors for candidiasis among non-trauma emergency surgery patients is lacking. This patient Background: candida is a significant pathogen among critically ill patients. however, candidiasis among non-trauma emergency surgery (NTeS) patients has not been previously investigated. herein we describe the incidence of both colonization and infection from candida and risk factors for invasive disease in this population. Results: Of all 289 eligible patients, 63 (21.7%) fulfilled the criteria for candida infection and 110 (38%) were included in the candida colonization group. Interestingly, from the 63 patients with invasive candidiasis, 25 (39.7%) were infected by a non-albicans species. Upon multivariate analyses, ventilator-associated pneumonia (Vap) (Odds Ratio [OR]: 2.34; 95%, confidence Interval [cI]: 1,213-4,533, p = 0.0112), bacteremia (OR: 4,778; 95% cI: 1,519-15,029, p = 0.0075) and surgical complications (OR: 3.903; 95% cI: 1,335-11,412, p = 0.0129) were independent risk factors for the development of candida infection. candida infection and colonization were both found to correlate with approximately $40,000-100,000 mean additional costs). Interestingly, candidemia was associated with 63% all-cause mortality. For all other forms of candidiasis, mortality was not significantly different among groups. Methods: For this retrospective single center study we included all NTeS patients with IcU stay ≥4 days from May 1 st , 2002 to april 30 th , 2007. patients were divided into 3 non-overlapping groups: (1) patients with candida-infection, (2) patients with candida colonization and (3) patients with negative candida cultures. Groups were compared by univariate and multivariate analyses to identify significant risk factors for invasive candidiasis. Conclusion: We found that candida infection is alarmingly high among NTeS patients with prolonged intensive care unit (IcU) stay. Surgical complications and bacterial infections (Vap and bacteraemia) were significantly correlated with the development of candidiasis. candidiasis reached a rate of 21.7/100 discharges, which is...

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Section: Introductionmentioning

confidence: 99%

Candidainfection and colonization among non-trauma emergency surgery patients

Kourkoumpetis

Manolakaki²,

Velmahos³

et al. 2010

Virulence

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“…I nvasive fungal infections (IFIs) are associated with significant morbidity, mortality, and health care costs in patients with hematologic malignancies (1,2). Allogeneic hematopoietic stem cell transplantation and chemotherapy-associated neutropenia place patients with acute myeloid leukemia (AML) at risk of developing an IFI (3).…”

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confidence: 99%

Safety and Pharmacokinetics of Isavuconazole as Antifungal Prophylaxis in Acute Myeloid Leukemia Patients with Neutropenia: Results of a Phase 2, Dose Escalation Study

Cornely

Böhme²,

Schmitt‐Hoffmann

et al. 2015

Antimicrob Agents Chemother

100

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Isavuconazole is a novel broad-spectrum triazole antifungal agent. This open-label dose escalation study assessed the safety and pharmacokinetics of intravenous isavuconazole prophylaxis in patients with acute myeloid leukemia who had undergone chemotherapy and had preexisting/expected neutropenia. Twenty-four patients were enrolled, and 20 patients completed the study. The patients in the low-dose cohort (n ‫؍‬ 11) received isavuconazole loading doses on day 1 (400/200/200 mg, 6 h apart) and day 2 (200/200 mg, 12 h apart), followed by once-daily maintenance dosing (200 mg) on days 3 to 28. The loading and maintenance doses were doubled in the high-dose cohort (n ‫؍‬ 12). The mean ؎ standard deviation plasma isavuconazole areas under the concentration-time curves for the dosing period on day 7 were 60.1 ؎ 22.3 g · h/ml and 113.1 ؎ 19.6 g · h/ml for the patients in the low-dose and high-dose cohorts, respectively. The adverse events in five patients in the low-dose cohort and in eight patients in the high-dose cohort were considered to be drug related. Most were mild to moderate in severity, and the most common adverse events were headache and rash (n ‫؍‬ 3 each). One patient in the high-dose cohort experienced a serious adverse event (unrelated to isavuconazole treatment), and two patients each in the low-dose and high-dose cohorts discontinued the study due to adverse events. Of the 20 patients who completed the study, 18 were classified as a treatment success. In summary, the results of this analysis support the safety and tolerability of isavuconazole administered at 200 mg and 400 mg once-daily as prophylaxis in immunosuppressed patients at high risk of fungal infections. (This study is registered at ClinicalTrials.gov under registration number NCT00413439.) I nvasive fungal infections (IFIs) are associated with significant morbidity, mortality, and health care costs in patients with hematologic malignancies (1, 2). Allogeneic hematopoietic stem cell transplantation and chemotherapy-associated neutropenia place patients with acute myeloid leukemia (AML) at risk of developing an IFI (3). Aspergillus spp. and Candida spp. are the predominant IFI pathogens in patients with acute leukemia (1, 3, 4). However, other molds, such as the Mucorales, Scedosporium spp., and Fusarium spp., are emerging as pathogens in this setting and are associated with high mortality rates (1).Because IFIs are often difficult to diagnose, and delays in treatment can significantly increase the risk of mortality (5, 6), antifungal prophylaxis has become a commonly used strategy in patients at high risk of IFIs (7, 8). Fluconazole, itraconazole, posaconazole, voriconazole, and micafungin are recommended for prophylactic use in patients with hematologic malignancies (9, 10). Although the results of randomized clinical trials support the prophylactic benefits of these agents (7,8,11), each may be limited in their use: fluconazole has no activity against molds (12); posaconazole demonstrates broad-spectrum activity against both yeasts and mo...

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“…Or, immunodépression et infections fongiques invasives vont de plus en plus souvent de pair. L'avènement des thérapeutiques immunosuppressives et l'épidémie de Sida expliquent l'incidence accrue de pathologies opportunistes comme la cryptococcose, l'aspergillose ou la zygomycose qui sont responsables d'une morbi-mortalité élevée et ont un coût non négligeable [7]. Leur de deux sous-unités, A catalytique et B régulatrice.…”

Section: Diversité Des Modes D'action Des Immunosuppresseurs Issus Deunclassified

Immunosuppresseurs et antifongiques

Rammaert

Lortholary

2010

Med Sci (Paris)

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Mortality, length of hospitalization, and costs associated with invasive fungal infections in high-risk patients

Abstract: Examination of a large database showed that, compared with high-risk patients without IFIs, those with IFIs had higher mortality, a longer hospital stay, and higher costs associated with their hospitalization.

Cited by 136 publications

References 19 publications

Candidainfection and colonization among non-trauma emergency surgery patients

Candidainfection and colonization among non-trauma emergency surgery patients

Safety and Pharmacokinetics of Isavuconazole as Antifungal Prophylaxis in Acute Myeloid Leukemia Patients with Neutropenia: Results of a Phase 2, Dose Escalation Study

Immunosuppresseurs et antifongiques

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