The Impact of Candidemia on Length of Hospital Stay, Outcome, and Overall Cost of Illness

Rentz, Anne M.; Halpern, Michael T.; Bowden, Raleigh

doi:10.1086/514955

Cited by 310Antifungal resistance and susceptibilityHealth Systems, Economic Evaluations, Quality of LifeFungal Infections and Studies

The Impact of Candidemia on Length of Hospital Stay, Outcome, and Overall Cost of Illness

Rentz, Anne M., Halpern, Michael T., Bowden, Raleigh·1998·Clinical Infectious Diseases

DOI 10.1086/514955

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Abstract

Although numerous studies have examined trends in nosocomial fungal infections, few have specifically addressed the cost of care associated with candidemia. This study analyzes the direct medical costs associated with treating candidemia in the United States. The study design was a cost-of-illness analysis estimating the average cost of candidemia for a single episode of care. Data were obtained from three sources: the 1993 Healthcare Cost and Utilization Project of the Agency for Health Care Policy and Research, the relevant literature, and a clinical expert in systemic fungal infections. The estimated cost (1997 U.S.$) of an episode of care for candidemia is $34,123 per Medicare patient and $44,536 per private insurance patient. The major cost associated with candidemia is that of an increased hospital stay. The estimated cost of care for candidemia may change in the future because of the use of more expensive antifungal treatments with improved safety and efficacy profiles.

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Crossref · 10.1086/514955

Cites

25 of 25 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 4 cited sources checked · 0 supported · 0 flagged

Findingreasoning
The total cost of treating adverse events was low.
“Total costs for the treatment of adverse events are low.”
Quote in the paperNot a substantial claim
Findingnone given
Annual costs follow the same patterns as per-patient costs.
“Annual costs follow the same patterns seen for per-patient costs.”
Quote in the paperNot a substantial claim
Findingown data
Candidemia leads to excess medical costs between $216 million and $281 million annually in the United States.
“we estimate that candidemia results in excess medical costs of $216 million to $281 million per year.”
Quote in the paperSubstantial claim
Findingown data
Diagnostic procedures accounted for 3% of total costs.
“Diagnostic procedure costs are 3% of the total.”
Quote in the paperNot a substantial claim
Findingown data
The annual incidence rate of candidemia was estimated at 2.43 cases per 100,000 population.
“The annual incidence of candidemia was determined to be 2.43 per 100,000 population.”
Quote in the paperNot a substantial claim

Classified as probably not a substantial claim. 4
The quote only partly states this claim. 1
May combine two claims. 4

Probably not a substantial claim: may not pass S1 (asserted), S4 (based). The quote only partly states this claim.
Findingnone given
The largest cost component of candidemia care was the extra hospital stay, which accounted for 85% to 90% of total costs for Medicare and private-pay patients.
“The major cost associated with candidemia is that of an increased hospital stay.”
Quote in the paperNot a substantial claim
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingcitation
A smaller group of patients (weighted average of 29%) received fluconazole therapy.
“A smaller group of patients (weighted average of 29%) re-ceived fluconazole therapy [14, 15].”
Quote in the paperNot a substantial claim0 of 2 sources checked
- cites [14] 14. Edwards JE Jr. Editorial response: should all patients with candidemia be 11. Donahue SP, Greven CM, Zuravleff JJ, et al. Intraocular candidiasis in treated with antifungal agents? Clin Infect Dis 1992; 15:422 -3. patients with candidemia. Clinical implications derived from a prospec- 22.
  Not checked in the free run.
- cites [15] 15. Hagan ME, Luchi M. Evaluation and treatment of candidemia in the tive multicenter study. Ophthalmology 1994; 101:1302 -9. nonneutropenic patient. Compr Ther 1994; 20:459 -64.
  Not checked in the free run.
May combine two claims.
Findingown data
In 1997 US dollars, the estimated cost of one candidemia episode of care was $34,123 for Medicare patients and $44,536 for private insurance patients.
“The estimated cost (1997 U.S. $) of an episode of care for candidemia is $34,123 per Medicare patient and $44,536 per private insurance patient.”
Quote in the paperSubstantial claim
May combine two claims.
Findingown data
The annual cost of candidemia is $215,863,998 for Medicare and $281,731,967 for private insurance.
“Total | $34,123 | $44,536 | $215,863,998 | $281,731,967”
Quote in the paperNot a substantial claim
May combine two claims.
Findingown data
Candidemic patients had a weighted average LOS of 36.3 days compared with 14.7 days for control patients.
“Weighted, average LOS* | 33.7 (33.8) 39.7 (36.4) 36.3 (41.4) 36.3 | 15.7 (22.9) 13.8 (26.5) 15.1 (22.4) 14.7 | .0001 .0001 .0001 . . .”
Quote in the paperSubstantial claim
May combine two claims.
Findingown data
The total per-patient cost of candidemia is $34,123 for Medicare patients and $44,536 for private insurance patients.
“Total | $34,123 | $44,536 | $215,863,998 | $281,731,967”
Quote in the paperSubstantial claim
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone given
Expert opinion was used only when necessary information could not be obtained from other sources.
“Expert opinion was used only when we could not otherwise obtain necessary information.”
Quote in the paperNot a substantial claim
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation
Controversy remains as to which drug is first-line therapy for candidemia.
“Controversy remains as to which drug is first-line therapy.”
Quote in the paperNot a substantial claim0 of 2 sources checked
- cites [26]
  Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [23]
  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

8 of 8

The paper relies on this without support.
Before this study, few or no studies had specifically examined the cost of care for candidemia.
“Although numerous studies have examined trends in nosocomial fungal infections, few have specifically addressed the cost of care associated with candidemia.”
The paper relies on this without support.
Candidemia develops in a subset of patients who are hospitalized for other reasons.
“rather, it develops in a subset of patients who are hospitalized for other reasons.”

2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Candidemia increased the length of hospitalization by 22 days and increased costs by $34,000-$44,000.
“One study found that candidemia increased the length of hospitalization by 22 days and increased costs by $34,000-$44,000 [138].”
From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [138]
Detection of resistance to amphotericin B by the CLSI M27-A2 BMD method has been problematic due to the very narrow range of MICs obtained.
“Detection of resistance to amphotericin B by the CLSI M27-A2 BMD method has been problematic due to the very narrow range of MICs obtained (191, 251, 253).”
From Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem (2007) · cites this paper as [251]

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Flagged first, then by citations

1 of the 26 references couldn’t be matched to a known paper.

Sorted by citations

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Pfaller, M. A., & Diekema, D. J. (2007) · Clinical Microbiology Reviews · doi:10.1128/cmr.00029-06 · Cited by 4,174 · see citing works
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Background
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Pappas, P. G., Rex, J. H., Sobel, J. D., Filler, S. G., Dismukes, W. E., Walsh, T. J., & Edwards, J. E. (2004) · Clinical Infectious Diseases · doi:10.1086/380796 · Cited by 1,440 · see citing works
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Background
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“Given the prevalence of Candida infections and their attributable impact on mortality and LOS, it is not surprising that these infections are associated with substantial health care costs (Fridkin 2005; Miller et al. 2001a; Pelz et al. 2000; Perlroth et al. 2007; Rentz et al. 1998; Wilson et al. 2002).”
BackgroundInfluential
A Prospective Observational Study of Candidemia: Epidemiology, Therapy, and Influences on Mortality in Hospitalized Adult and Pediatric Patients
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Background
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Method
Candida Infections of the Genitourinary Tract
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Background
EngineeredControl of Cell Morphology In Vivo Reveals Distinct Roles for Yeast andFilamentous Forms of Candida albicans duringInfection
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Background
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Background
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Background
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“1%, respectively) and longer intensive care unit lengths of stay (median [interquartile range]) (33 days [18–44], 20 days [9–43], and 21 days [8–46], respectively); however, these differences were not statistically significant.”
Background
Epidemiology of invasive candidiasis
Arendrup, M. C. (2010) · Current Opinion in Critical Care · doi:10.1097/mcc.0b013e32833e84d2 · Cited by 376 · see citing works
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“The “best” rule was selected by team consensus using the following criteria before it was applied to the validation sample: (1) the proportion of all IC cases contained in the subpopulation defined by the rule; (2) the risk of IC in the subpopulation defined by the rule; (3) the relative risk of IC in the subpopulatio…”
Method
Candida albicans - Biology, molecular characterization, pathogenicity, and advances in diagnosis and control – An update
Dadar, M., Tiwari, R., Karthik, K., Chakraborty, S., Shahali, Y., & Dhama, K. (2018) · Microbial Pathogenesis · doi:10.1016/j.micpath.2018.02.028 · Cited by 338 · see citing works
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Background
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Method
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“In one analysis, the estimated cost of an IC BSI episode was $34,123 per Medicare patient and $44,536 per private insurance patient (1997, US$), with an overall economic burden of $2 billion dollars annually in the USA (Rentz et al., 1998).”
Background
Cost-of-Illness Studies
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Ostrosky-Zeichner, L., & Pappas, P. G. (2006) · Critical Care Medicine · doi:10.1097/01.ccm.0000201897.78123.44 · Cited by 247 · see citing works
All you need is light
Denis, T. G. S., Dai, T., Izikson, L., Astrakas, C., Anderson, R. R., Hamblin, M. R., & Tegos, G. P. (2011) · Virulence · doi:10.4161/viru.2.6.17889 · Cited by 241 · see citing works
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“In addition to an attributable mortality of 40–49%, invasive candidiasis is associated with increased length of stay(6,7) and increased healthcare expenditure.(8,9) Risk factors for invasive candidiasis and mortality secondary to invasive candidiasis are well described.”
Background
Assessment of preemptive treatment to prevent severe candidiasis in critically ill surgical patients(*)
Piarroux, R., Grenouillet, F., Balvay, P., Tran, V., Blasco, G., Millon, L., & Boillot, A. (2004) · Critical Care Medicine · doi:10.1097/01.ccm.0000147726.62304.7f · Cited by 213 · see citing works
“The estimated cost of one case of proven candidiasis is close to 35,000 (€) (42, 43).”
Background
Bench-to-bedside review: Candida infections in the intensive care unit
Méan, M., Marchetti, O., & Calandra, T. (2008) · Critical Care · doi:10.1186/cc6212 · Cited by 217 · see citing works
“Candidaemia is also associated with prolonged duration of mechanical ventilation and hospital stay, and increased health care costs [28,36-38].”
Background
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“Cardiovascular Hypotension 23 (17) 16 (12) Cardiac arrest 14 (11) 8 (6)”
Background
Epidemiology of candidemia in intensive care units
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“The extra cost of an episode of candidemia in adults has been estimated as US$44,000 and € 16,000 by two studies [37,45], and candidemia was associated with a US$28,000 increase in the hospital cost of neonates [46].”
Background
Rules for identifying patients at increased risk for candidal infections in the surgical intensive care unit: approach to developing practical criteria for systematic use in antifungal prophylaxis trials
Paphitou, N. I., Ostrosky-Zeichner, L., & Rex, J. H. (2005) · Medical Mycology · doi:10.1080/13693780410001731619 · Cited by 179 · see citing works
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“5 days, respectively, and increased total costs [8–10].”
Background
Nosocomial fungal infections: candidemia
Lunel, F. M. V., Meis, J. F. G. M., & Voß, A. (1999) · Diagnostic Microbiology and Infectious Disease · doi:10.1016/s0732-8893(99)00035-8 · Cited by 168 · see citing works
“Candidemia therefore is not only a life-threatening yeast infection, but furthermore significantly increases the costs of health care (Rentz et al. 1998).”
Background
Surface Glycans ofCandida albicansand Other Pathogenic Fungi: Physiological Roles, Clinical Uses, and Experimental Challenges
Masuoka, J. (2004) · Clinical Microbiology Reviews · doi:10.1128/cmr.17.2.281-310.2004 · Cited by 165 · see citing works
“Increased morbidity due to nosocomial fungal infections also takes a heavy toll, resulting in longer hospital stays (49, 178, 314) and higher patient care costs (91, 234, 285).”
Background
Association of Fluconazole Area under the Concentration-Time Curve/MIC and Dose/MIC Ratios with Mortality in Nonneutropenic Patients with Candidemia
Pai, M. P., Turpin, R. S., & Garey, K. W. (2006) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00474-06 · Cited by 160 · see citing works
“Clinical outcomes for patients with candidemia are also influenced by host factors such as age, severity of illness, and comorbid conditions (28).”
Background
Antifungal agents for preventing fungal infections in non-neutropenic critically ill and surgical patients: systematic review and meta-analysis of randomized clinical trials
Playford, E. G., Webster, A. C., Sorrell, T. C., & Craig, J. C. (2006) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dki491 · Cited by 159 · see citing works
Systemic candidiasis in intensive care units: A multicenter, matched-cohort study
Leleu, G., Aegerter, P., & Guidet, B. (2002) · Journal of Critical Care · doi:10.1053/jcrc.2002.35815 · Cited by 160 · see citing works
Epidemiologia das infecções hematogênicas por Candida spp
Colombo, A. L., & Guimarães, T. (2003) · Revista da Sociedade Brasileira de Medicina Tropical · doi:10.1590/s0037-86822003000500010 · Cited by 156 · see citing works
Secular Trends of Candidemia Over 12 Years in Adult Patients at a Tertiary Care Hospital
GARBINO, J., KOLAROVA, L., ROHNER, P., LEW, D., PICHNA, P., & PITTET, D. (2002) · Medicine · doi:10.1097/00005792-200211000-00003 · Cited by 143 · see citing works
Positive Fungal Cultures in Burn Patients: A Multicenter Review
Ballard, J., Edelman, L. S., Saffle, J. R., Sheridan, R. L., Kagan, R. J., Bracco, D., Cancio, L. C., Cairns, B. A., Baker, R., Fillari, P., et al. (2008) · Journal of Burn Care & Research · doi:10.1097/bcr.0b013e31815f6ecb · Cited by 143 · see citing works
Epidemiology of Candidemia in a Tertiary Care Centre of North India: 5-Year Study
Xess, I., Jain, N., Hasan, M. F., Mandal, P., & Banerjee, U. (2007) · Infection · doi:10.1007/s15010-007-6144-6 · Cited by 143 · see citing works
“is the fourth most common pathogen associated with bloodstream infection worldwide [1, 2].”
Background
Economic Impact of Candida Colonization and Candida Infection in the Critically Ill Patient
Jord�, R., Nolla‐Salas, J., Le�n-Regidor, M. A., lvarez-Lerma, F., Olaechea, P., Palomar, M., & Le�n-Gil, C. (2004) · European Journal of Clinical Microbiology & Infectious Diseases · doi:10.1007/s10096-004-1104-x · Cited by 130 · see citing works
“[18], who demonstrated that patients with candidemia had an additional 34 days of hospitalization compared to patients without candidemia.”
Result
The case for antifungal stewardship
Ananda-Rajah, M. R., Slavin, M. A., & Thursky, K. (2011) · Current Opinion in Infectious Diseases · doi:10.1097/qco.0b013e32834e0680 · Cited by 128 · see citing works
Invasive candidiasis in immunocompromised hospitalized patients.
Sims, C. R., Ostrosky-Zeichner, L., & Rex, J. H. (2005) · Archives of Medical Research · doi:10.1016/j.arcmed.2005.05.015 · Cited by 124 · see citing works
The global epidemiology of invasive Candida infections—is the tide turning?
Hobson, R. P. (2003) · Journal of Hospital Infection · doi:10.1016/j.jhin.2003.08.012 · Cited by 123 · see citing works
Changing Strategies for the Management of Invasive Fungal Infections
Rapp, R. P. (2004) · Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy · doi:10.1592/phco.24.3.4s.33151 · Cited by 123 · see citing works
“For example, a 1998 report estimated that nosocomial candidemia costs in the United States are about $200 million/year.(58) That estimate, however, was based on an underestimation of the incidence of the illness.”
Background
Invasive candidiasis in pediatric intensive care patients: epidemiology, risk factors, management, and outcome
Filioti, J., Spiroglou, K., & Roilides, E. (2007) · Intensive Care Medicine · doi:10.1007/s00134-007-0672-5 · Cited by 121 · see citing works
“and mortality, prolongation of hospital stay, and increased cost [1].”
Background
The clinical significance of Candida colonization of respiratory tract secretions in critically ill patients
Delisle, M.-S., Williamson, D. R., Perreault, M. M., Albert, M., Jiang, X., & Heyland, D. K. (2008) · Journal of Critical Care · doi:10.1016/j.jcrc.2008.01.005 · Cited by 119 · see citing works
“Fungal infection and colonization are becoming major clinical challenges in patients in the intensive care unit (ICU) [1-12].”
Background
Improvement of a clinical prediction rule for clinical trials on prophylaxis for invasive candidiasis in the intensive care unit
Ostrosky‐Zeichner, L., Pappas, P. G., Shoham, S., Reboli, A. C., Barron, M. A., Sims, C. R., Wood, C. A., & Sobel, J. D. (2009) · Mycoses · doi:10.1111/j.1439-0507.2009.01756.x · Cited by 122 · see citing works
Antifungal susceptibilities of Candida glabrata species complex, Candida krusei, Candida parapsilosis species complex and Candida tropicalis causing invasive candidiasis in China: 3 year national surveillance
Xiao, M., Fan, X., Chen, S. C. ‐., Wang, H., Sun, Z., Liao, K., Chen, S.-L., Yan, Y., Kang, M., Hu, Z.-D., et al. (2014) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dku460 · Cited by 123 · see citing works
Molecular Epidemiology of Candidemia: Evidence of Clusters of Smoldering Nosocomial Infections
Ásmundsdóttir, L. R., Erlendsdóttir, H., Haraldsson, G., Guo, H., Xu, J., & Gottfreðsson, M. (2008) · Clinical Infectious Diseases · doi:10.1086/589298 · Cited by 116 · see citing works
“In particular, candidemia is associated with mortality rates as high as 49% and an excessive length of hospital stay [4, 5].”
Background
Candida albicansand cancer: Can this yeast induce cancer development or progression?
Ramirez‐Garcia, A., Rementerı́a, A., Urízar, J. M. A., Moragues, M. D., Antoran, A., Pellón, A., Abad, A., & Hernando, F. L. (2014) · Critical Reviews in Microbiology · doi:10.3109/1040841x.2014.913004 · Cited by 120 · see citing works
“As a complication of cancer and its treatment, these infections are associated with a higher mortality rate, prolonged hospitalization and rising healthcare costs (Leleu et al., 2002; Morgan et al., 2005; Pfaller & Diekema, 2007; Rentz et al., 1998; Sipsas et al., 2009; Wey et al., 1988; Zaoutis et al., 2005).”
Background
How Chemotherapy Increases the Risk of Systemic Candidiasis in Cancer Patients: Current Paradigm and Future Directions
Teoh, F., & Pavelka, N. (2016) · Pathogens · doi:10.3390/pathogens5010006 · Cited by 115 · see citing works
“This trend has been observed over the past decade and is still the case, even in developed countries such as the United States, Denmark, Norway, and Finland [13].”
Background
Estimating the Cost of Nosocomial Candidemia in the United States
Miller, L. G., Hajjeh, R. A., & Edwards, J. E. (2001) · Clinical Infectious Diseases · doi:10.1086/319613 · Cited by 109 · see citing works
Identification of Antifungal Compounds Active against Candida albicans Using an Improved High-Throughput Caenorhabditis elegans Assay
Okoli, I. G., Coleman, J. J., Tempakakis, E., An, W. F., Holson, E. B., Wagner, F. F., Conery, A. L., Larkins‐Ford, J., Wu, G., Stern, A., et al. (2009) · PLoS ONE · doi:10.1371/journal.pone.0007025 · Cited by 107 · see citing works
“dollars) [44].”
Comparison of costs, length of stay, and mortality associated with Candida glabrata and Candida albicans bloodstream infections
Moran, C., Grussemeyer, C. A., Spalding, J. R., Benjamin, D. K., & Reed, S. D. (2010) · American Journal of Infection Control · doi:10.1016/j.ajic.2009.06.014 · Cited by 91 · see citing works
Systemic mycoses in the immunocompromised host: an update in antifungal therapy
Kontoyiannis, D. P., Mantadakis, E., & Samonis, G. (2003) · Journal of Hospital Infection · doi:10.1053/jhin.2002.1278 · Cited by 96 · see citing works
Anidulafungin compared with fluconazole for treatment of candidemia and other forms of invasive candidiasis caused by Candida albicans: a multivariate analysis of factors associated with improved outcome
Reboli, A. C., Shorr, A. F., Rotstein, C., Pappas, P. G., Kett, D. H., Schlamm, H. T., Reisman, A. L., Biswas, P., & Walsh, T. J. (2011) · BMC Infectious Diseases · doi:10.1186/1471-2334-11-261 · Cited by 95 · see citing works
“, candidemia and other forms of invasive candidiasis) continue to contribute to excess morbidity, greater mortality, prolonged hospitalizations, and increased costs [1,2].”
Background
Empirical Anti-Candida Therapy among Selected Patients in the Intensive Care Unit: A Cost-Effectiveness Analysis
Golan, Y., Wolf, M. P., Pauker, S. G., Wong, J. B., & Hadley, S. (2005) · Annals of Internal Medicine · doi:10.7326/0003-4819-143-12-200512200-00004 · Cited by 93 · see citing works
Secular trend in candidemia and the use of fluconazole in Finland, 2004-2007
Poikonen, E., Lyytikäinen, O., Anttila, V.-J., Koivula, I., Lumio, J., Kotilainen, P., Syrjälä, H., & Ruutu, P. (2010) · BMC Infectious Diseases · doi:10.1186/1471-2334-10-312 · Cited by 92 · see citing works
“represent a considerable burden in hospitalized patients and are associated with high mortality and an excess length of stay [1-5].”
Background
Antifungal agents for preventing fungal infections in non-neutropenic critically ill patients
Cortegiani, A., Russotto, V., Maggiore, A., Attanasio, M., Naro, A. R., Raineri, S. M., & Giarratano, A. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004920.pub3 · Cited by 91 · see citing works
Supplement: Trends in invasive Candida infections and their treatment: focus on echinocandins
Lewis, R. E. (2009) · Current Medical Research and Opinion · doi:10.1185/03007990902990817 · Cited by 89 · see citing works
Treatment options of invasive fungal infections in adults
Marchetti, O., Eggimann, P., Pittet, D., Glauser, M., & Calandra, T. (2006) · Swiss Medical Weekly · doi:10.4414/smw.2006.11392 · Cited by 89 · see citing works
Candidemia in a Brazilian hospital: the importance of Candida parapsilosis
Medrano, D. J. A., Brilhante, R. S. N., Cordeiro, R. D. A., Rocha, M. F. G., Rabenhorst, S. H. B., & Sidrim, J. J. C. (2006) · Revista do Instituto de Medicina Tropical de São Paulo · doi:10.1590/s0036-46652006000100004 · Cited by 89 · see citing works
Invasive candidiasis in long-term patients at a multidisciplinary intensive care unit: Candida colonization index, risk factors, treatment and outcome
Agvald‐Öhman, C., Klingspor, L., Hjelmqvist, H., & Edlund, C. (2008) · Scandinavian Journal of Infectious Diseases · doi:10.1080/00365540701534509 · Cited by 87 · see citing works
“Mortality rates associated with candidaemia have been reported to range between 38 and 75% [3], and the morbidity is estimated to result in an excess hospital stay of 6 34 d [4].”
Background
New approaches to the risk of Candida in the intensive care unit
Ostrosky‐Zeichner, L. (2003) · Current Opinion in Infectious Diseases · doi:10.1097/00001432-200312000-00004 · Cited by 86 · see citing works
Attributable Hospital Cost and Antifungal Treatment of Invasive Fungal Diseases in High-Risk Hematology Patients: an Economic Modeling Approach
Ananda-Rajah, M. R., Cheng, A., Morrissey, C. O., Spelman, T. D., Dooley, M. J., Neville, A. M., & Slavin, M. A. (2011) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.01423-10 · Cited by 85 · see citing works
“12 Antifungal drugs 26,219 4,775 21,444 (27) 0.”
BackgroundMethodResultInfluential
Validation and comparison of clinical prediction rules for invasive candidiasis in intensive care unit patients: a matched case-control study
Hermsen, E. D., Zapapas, M. K., Maiefski, M., Rupp, M. E., Freifeld, A. G., & Kalil, A. C. (2011) · Critical Care · doi:10.1186/cc10366 · Cited by 83 · see citing works
“The clinical and economic burden of invasive candidiasis is significant, as these infections are associated with increased mortality, longer hospital stay and higher cost [4].”
Background
A Prospective Surveillance Study of Candidaemia: Epidemiology, Risk Factors, Antifungal Treatment and Outcome in Hospitalized Patients
Rajendran, R., Sherry, L., Deshpande, A., Johnson, E. M., Hanson, M., Williams, C., Munro, C. A., Jones, B., & Ramage, G. (2016) · Frontiers in Microbiology · doi:10.3389/fmicb.2016.00915 · Cited by 82 · see citing works
“Candida species remain a significant cause of nosocomial bloodstream infections (BSIs), associated with prolonged hospital stay in the ICU and high healthcare cost (Rentz et al., 1998; Gudlaugsson et al., 2003).”
Background
Two hundred and eleven cases of Candida osteomyelitis: 17 case reports and a review of the literature
Slenker, A. K., Keith, S. W., & Horn, D. L. (2012) · Diagnostic Microbiology and Infectious Disease · doi:10.1016/j.diagmicrobio.2012.02.004 · Cited by 84 · see citing works
“6% to 57% (Pappas et al., 2003; Gudlaugsson et al., 2003; Morgan et al., 2005; Miller et al., 2001; National Nosocomial Infections Surveillance, 1999; Rentz et al., 1998; Wey et al., 1988; Zaoutis et al., 2005).”
BackgroundInfluential
Risk Factors for Fluconazole-Resistant Candida glabrata Bloodstream Infections
Lee, I., Fishman, N. O., Zaoutis, T. E., Morales, K. H., Weiner, M. G., Synnestvedt, M. B., Nachamkin, I., & Lautenbach, E. (2009) · Archives of Internal Medicine · doi:10.1001/archinte.169.4.379 · Cited by 82 · see citing works
“of the following criteria: (1) receipt within the previous 30 days”
Contribution of the PlateliaCandida-Specific Antibody and Antigen Tests to Early Diagnosis of SystemicCandida tropicalisInfection in Neutropenic Adults
Sendid, B., Caillot, D., Baccouch-Humbert, B., Klingspor, L., Grandjean, M., Bonnin, A., & Poulain, D. (2003) · Journal of Clinical Microbiology · doi:10.1128/jcm.41.10.4551-4558.2003 · Cited by 79 · see citing works
“Moreover, the increased morbidity as a result of candidemia generates important extra costs related to longer hospital stays and prophylactic, empirical, or curative antifungal treatment (33).”
Background
Temporal Assessment of Candida Risk Factors in the Surgical Intensive Care Unit
McKinnon, P. S. (2001) · Archives of Surgery · doi:10.1001/archsurg.136.12.1401 · Cited by 79 · see citing works
Candida albicans —A systematic review to inform the World Health Organization Fungal Priority Pathogens List
Parambath, S., Dao, A., Kim, H. Y., Zawahir, S., Alastruey‐Izquierdo, A., Tacconelli, E., Govender, N. P., Oladele, R. O., Colombo, A. L., Sorrell, T. C., et al. (2024) · Medical Mycology · doi:10.1093/mmy/myae045 · Cited by 82 · see citing works
“Hospital lengths of stay of 2–4 weeks (and up to 40–60 days in patients with endocarditis) 74 , 75 were found and are a reasonable starting estimate.”
Background
The Economic Burden of Candidemia and Invasive Candidiasis: A Systematic Review
Ismail, W. N. W., Jasmi, N., Khan, T. M., Hong, Y. H., & Neoh, C. F. (2019) · Value in Health Regional Issues · doi:10.1016/j.vhri.2019.07.002 · Cited by 80 · see citing works
The Burden of Appendicitis-Related Hospitalizations in the United States in 1997
Davies, G., Dasbach, E. J., & Teutsch, S. M. (2004) · Surgical Infections · doi:10.1089/sur.2004.5.160 · Cited by 78 · see citing works
Candidemia and invasive candidiasis: A review of the literature for the burns surgeon
Ha, J. F., Italiano, C. M., Heath, C. H., Shih, S., Rea, S. M., & Wood, F. M. (2010) · Burns · doi:10.1016/j.burns.2010.01.005 · Cited by 76 · see citing works
“It has been estimated that each episode of invasive candidiasis costs approximately $40,000 US ( A$43,000) [14] with the estimated cost likely to increase further with the widespread use of newer, more expensive antifungal agents [53].”
Impact of selective decontamination of the digestive tract on fungal carriage and infection: systematic review of randomized controlled trials
Silvestri, L., SAENE, H. K. F. V., Milanese, M., & Gregori, D. (2005) · Intensive Care Medicine · doi:10.1007/s00134-005-2654-9 · Cited by 73 · see citing works
“The mortality directly attributable to the infection itself ranges from 22% to 38% [20, 101, 102, 103, 104 ].”
Background
Candidemia in a pediatric intensive care unit
Singhi, S. C., Thimmapuram, C. R., & Chakrabarti, A. (2004) · Pediatric Critical Care Medicine · doi:10.1097/01.pcc.0000123550.68708.20 · Cited by 73 · see citing works
“Candida was the most common fungal pathogen associated with invasive disease in pediatric ICUs (9).”
BackgroundInfluential
CANDIDA ALBICANS AND NON-ALBICANS BLOODSTREAM INFECTIONS IN ADULT AND PEDIATRIC PATIENTS
Moran, C., Grussemeyer, C. A., Spalding, J. R., Benjamin, D. K., & Reed, S. D. (2009) · The Pediatric Infectious Disease Journal · doi:10.1097/inf.0b013e3181920ffd · Cited by 70 · see citing works
“A 1997 analysis estimated the cost of candidemia in adults to be approximately $34,000 to $45,000.(6) A study of candidemia in children found a mortality rate of 16%, mean length of stay of 45 days, and hospital charges of approximately $184,000.”
Background
A C. elegans-based, whole animal, in vivo screen for the identification of antifungal compounds
Tampakakis, E., Okoli, I. G., & Mylonakis, E. E. (2008) · Nature Protocols · doi:10.1038/nprot.2008.193 · Cited by 72 · see citing works
“infections is more than d1 billion (1998 US dollars”
Background
The Toll-like receptors and their role in septic shock
Cristofaro, P. A., & Opal, S. M. (2003) · Expert Opinion on Therapeutic Targets · doi:10.1517/14728222.7.5.603 · Cited by 72 · see citing works
Attributable Mortality of Candida Bloodstream Infections in the Modern Era: A Propensity Score Analysis
Mazi, P. B., Olsen, M. A., Stwalley, D., Rauseo, A. M., Ayres, C., Powderly, W. G., & Spec, A. (2022) · Clinical Infectious Diseases · doi:10.1093/cid/ciac004 · Cited by 68 · see citing works
Epidemiology, risk factors, and outcomes of Candida albicans versus non- albicans candidemia in nonneutropenic patients
Davis, S. L., Vazquez, J. A., & Mckinnon, P. S. (2007) · Annals of Pharmacotherapy · doi:10.1345/aph.1h516 · Cited by 71 · see citing works
Candidaemia and antifungal therapy in a French University Hospital: rough trends over a decade and possible links
Sendid, B., Cotteau, A., François, N., d’Haveloose, A., Standaert‐Vitse, A., Camus, D., & Poulain, D. (2006) · BMC Infectious Diseases · doi:10.1186/1471-2334-6-80 · Cited by 71 · see citing works
“Their economic impact has also been recognised, linked largely to the empirical use of systemic antifungal drugs and a prolongation of hospital stay (on average 30 days), which is necessary for optimal treatment and control of candidaemia [20,21].”
Background
Epidemiology ofCandidablood stream infections in patients with hematological malignancies or solid tumors
Zirkel, J., Klinker, H., Kuhn, A., Abele‐Horn, M., Tappe, D., Turnwald, D., Einsele, H., & Heinz, W. (2012) · Medical Mycology · doi:10.3109/13693786.2011.587211 · Cited by 71 · see citing works
Canadian Clinical Practice Guidelines for Invasive Candidiasis in Adults
Bow, E. J., Evans, G. A., Fuller, J., Laverdière, M., Rotstein, C., Rennie, R. P., Shafran, S. D., Sheppard, D. C., Carle, S., Phillips, P., et al. (2010) · Canadian Journal of Infectious Diseases and Medical Microbiology · doi:10.1155/2010/357076 · Cited by 68 · see citing works
Rapid Identification of Commonly EncounteredCandidaSpecies Directly from Blood Culture Bottles
Selvarangan, R., Bui, U. T. T., Limaye, A. P., & Cookson, B. T. (2003) · Journal of Clinical Microbiology · doi:10.1128/jcm.41.12.5660-5664.2003 · Cited by 67 · see citing works
“Rapid identification of the fungal pathogen directly from clinical samples and institution of early therapy may help to reduce the hospital stay and high overall costs associated with management of candidemia (17).”
Background
Inadequacy of fluconazole dosing in patients with candidemia based on Infectious Diseases Society of America (IDSA) guidelines
Garey, K. W., Pai, M. P., Suda, K. J., Turpin, R. S., Rege, M., Mingo, D. E., & Bearden, D. T. (2007) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.1365 · Cited by 63 · see citing works
Changing spectrum of invasive candidiasis and its therapeutic implications
Singh, N. (2001) · Clinical Microbiology and Infection · doi:10.1111/j.1469-0691.2001.tb00004.x · Cited by 66 · see citing works
Recommendations for the treatment of established fungal infections
Thursky, K., Playford, E. G., Seymour, J. F., Sorrell, T. C., Ellis, D. H., Guy, S., Gilroy, N. M., Chu, J., & Shaw, D. (2008) · Internal Medicine Journal · doi:10.1111/j.1445-5994.2008.01725.x · Cited by 66 · see citing works
Excess Costs of Hospital Care Associated With Neonatal Candidemia
Smith, P. B., Morgan, J., Benjamin, D. K., Fridkin, S. K., Sanza, L. T., Harrison, L. H., Sofair, A. N., Huie-White, S., & Benjamin, D. K. (2007) · Pediatric Infectious Disease Journal · doi:10.1097/01.inf.0000253973.89097.c0 · Cited by 65 · see citing works
“These results are consistent with findings in older patients.(8,11,12,22) A survey of 1624 patients with a discharge diagnosis of candidemia identified from the 1993 Nationwide Inpatient Sample found that, compared with uninfected patients, adult patients with candidemia experienced inpatient stays 34 days longer and…”
BackgroundResult
Multilocus Sequence Typing for Analyses of Clonality of Candida albicans Strains in Taiwan
Chen, K.-W., Chen, Y., Lo, H., Odds, F. C., Wang, T.-H., Lin, C.-Y., & Li, S.-Y. (2006) · Journal of Clinical Microbiology · doi:10.1128/jcm.00320-06 · Cited by 64 · see citing works
“albicans result in increased lengths of hospital stays and medical costs (31, 34).”
Background
Burden of early-onset candidemia: analysis of culture-positive bloodstream infections from a large U.S. database
Shorr, A. F., Gupta, V., Sun, X., Johannes, R. S., Spalding, J., & Tabak, Y. P. (2009) · Critical Care Medicine · doi:10.1097/ccm.0b013e3181a0f95d · Cited by 62 · see citing works
“A study, using claims data, showed that the higher hospital costs of candidemia were related to increased LOS (11).”
BackgroundResultInfluential
Invasive Candidiasis in Critically Ill Patients: A Prospective Cohort Study in Two Tertiary Care Centers
Al‐Dorzi, H. M., Sakkijha, H., Khan, R., Aldabbagh, T., Toledo, A., Ntinika, P., Johani, S. M. A., & Arabi, Y. M. (2018) · Journal of Intensive Care Medicine · doi:10.1177/0885066618767835 · Cited by 63 · see citing works
“candidemia had a major impact on hospital length of stay with an average increase of >34 days and an estimated care cost of US$34 123 per affected Medicare patient.(11) Another study showed that candidemia in adult hospitalized patients was associated with 14.”
Background
Cost of invasive fungal infections in the era of new diagnostics and expanded treatment options
Ashley, E. D., Drew, R., Johnson, M., Danna, R., Dabrowski, D., Walker, V., Prasad, M., Alexander, B., Papadopoulos, G., & Perfect, J. (2012) · Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy · doi:10.1002/j.1875-9114.2012.01124 · Cited by 62 · see citing works
Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting
Lepak, A., & Andes, D. (2011) · Critical Care Clinics · doi:10.1016/j.ccc.2010.11.001 · Cited by 62 · see citing works
Candida in Burns: Risk Factors and Outcomes
Moore, E. C., Padiglione, A. A., Wasiak, J., Paul, E. M., & Cleland, H. J. (2010) · Journal of Burn Care & Research · doi:10.1097/bcr.0b013e3181d0f536 · Cited by 61 · see citing works
“Candidaemia has been described as a preterminal phenomenon,(25) leading to increased length of stay, mortality, and overall cost.(15,18,22)”
Background
Burden of hospitalization of patients with Candida and Aspergillus infections in Australia
Slavin, M. A., Fastenau, J. M., Sukarom, I., Mavros, P., Crowley, S. J., & Gerth, W. C. (2003) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2003.05.001 · Cited by 61 · see citing works
Factors Related to Hospital Stay Among Patients With Nosocomial Infection Acquired in the Intensive Care Unit
Olaechea, P., Ulibarrena, M. Á., Álvarez-Lerma, F., et al. (2003) · Infection Control and Hospital Epidemiology · doi:10.1086/502191 · Cited by 60 · see citing works

Excess Costs of Hospital Care Associated With Neonatal Candidemia
Smith, P. B., Morgan, J., Benjamin, D. K., Fridkin, S. K., Sanza, L. T., Harrison, L. H., Sofair, A. N., Huie-White, S., & Benjamin, D. K. (2007) · Pediatric Infectious Disease Journal · doi:10.1097/01.inf.0000253973.89097.c0 · Cited by 65 · see citing works
Candida infections: outcome and attributable ICU costs in critically ill patients
Pelz, R. K., Lipsett, P. A., Swoboda, S. M., Diener-West, M., Powe, N. R., Brower, R. G., Perl, T. M., Hammond, J. M., & Hendrix, C. W. (2000) · Journal of Intensive Care Medicine · doi:10.1046/j.1525-1489.2000.00255.x · Cited by 45 · see citing works
The impact of candidemia on length of stay, outcomes, and overall cost of illness
Rentz, A. C., Halpern, M. T., & Bowden, R. A. (1998) · Clinical Infectious Diseases · Cited by 2 · see citing works
Self-citation
Mortality, Hospital Stay, and Costs Associated With Candidemia After Major Esophagus, Stomach, and Bowel Procedures in US Hospitals
Wood, C. A., Rajagopalan, S., Shivaprakash, M., Chandwani, S., & Turpin, R. S. (2009) · Infectious Diseases in Clinical Practice · doi:10.1097/ipc.0b013e31819fe424
Estimating the Cost of Nosocomial Candidemia in the United States
Miller, L. G., Hajjeh, R. A., & Edwards, J. E. (2001) · Clinical Infectious Diseases · doi:10.1086/319613 · Cited by 109 · see citing works

Authors: Rentz, A. M., Halpern, M. T., & Bowden, R.
Corresponding author: Rentz, Anne M.
ORCID: Halpern, Michael T.
Venue: Clinical Infectious Diseases
Publisher: Oxford University Press (OUP)
Published: 1998-10
Volume: 27
Issue: 4
Pages: 781-788
ISSN: 1058-4838 (ISSN-L)
1537-6591
DOI: 10.1086/514955
OpenAlex: W2114509444
Cited by: 310
References: 26
Citations by year: 2026: 2 · 2024: 2 · 2023: 1 · 2022: 6 · 2021: 3 · 2020: 4 · 2019: 3 · 2018: 7 · 2017: 6 · 2016: 7 · 2015: 12 · 2014: 11 · 2013: 14 · 2012: 16
FWCI: 3.77
Type: journal article
Language: en
Open access: closed
Locations: Clinical Infectious Diseases (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
Keywords: candidemia, economic burden, length of hospital stay, nosocomial fungal infections, Medicare, private insurance, health care costs, patient outcomes
MeSH terms: Adolescent, Adult, Aged, Candidiasis, Female, Hospitalization, Humans, Male, Middle Aged, Time Factors, United States, Incidence, Fungemia, Health Care Costs

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The Impact of Candidemia on Length of Hospital Stay, Outcome, and Overall Cost of Illness

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