Inappropriate empiric antifungal therapy for candidemia in the ICU and hospital resource utilization: a retrospective cohort study

Zilberberg, Marya D; Kollef, Marin H; Arnold, Heather; Labelle, Andrew; Micek, Scott T; Kothari, Smita; Shorr, Andrew F

doi:10.1186/1471-2334-10-150

Cited by 128Antifungal resistance and susceptibilityAntibiotic Use and ResistanceOcular Infections and Treatments

Inappropriate empiric antifungal therapy for candidemia in the ICU and hospital resource utilization: a retrospective cohort study

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Zilberberg, Marya D, Kollef, Marin H, Arnold, Heather, Labelle, Andrew, Micek, Scott T, Kothari, Smita, Shorr, Andrew F·2010·BMC Infectious Diseases

DOI 10.1186/1471-2334-10-150PMC PMC2890008

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Abstract

BACKGROUND: Candida represents the most common cause of invasive fungal disease, and candidal blood stream infections (CBSI) are prevalent in the ICU. Inappropriate antifungal therapy (IAT) is known to increase a patient's risk for death. We hypothesized that in an ICU cohort it would also adversely affect resource utilization. METHODS: We retrospectively identified all patients with candidemia on or before hospital day 14 and requiring an ICU stay at Barnes-Jewish Hospital between 2004 and 2007. Hospital length of stay following culture-proven onset of CBSI (post-CBSI HLOS) was primary and hospital costs secondary endpoints. IAT was defined as treatment delay of > or =24 hours from candidemia onset or inadequate dose of antifungal agent active against the pathogen. We developed generalized linear models (GLM) to assess independent impact of inappropriate therapy on LOS and costs. RESULTS: Ninety patients met inclusion criteria. IAT was frequent (88.9%). In the IAT group antifungal delay > or =24 hours occurred in 95.0% and inappropriate dosage in 26.3%. Unadjusted hospital mortality was greater among IAT (28.8%) than non-IAT (0%) patients, p = 0.059. Both crude post-CBSI HLOS (18.4 +/- 17.0 vs. 10.7 +/- 9.4, p = 0.062) and total costs ($66,584 +/- $49,120 vs. $33,526 +/- $27,244, p = 0.006) were higher in IAT than in non-IAT. In GLMs adjusting for confounders IAT-attributable excess post-CBSI HLOS was 7.7 days (95% CI 0.6-13.5) and attributable total costs were $13,398 (95% CI $1,060-$26,736). CONCLUSIONS: IAT of CBSI, such as delays and incorrect dosing, occurs commonly. In addition to its adverse impact on clinical outcomes, IAT results in substantial prolongation of hospital LOS and increase in hospital costs. Efforts to enhance rates of appropriate therapy for candidemia may improve resource use.

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Inadequate dosing of antifungals in patients with invasive candidiasis is associated with increased length of hospital stay, health care costs, morbidity, and mortality.
“Numerous reports have documented the association between inadequate dosing of antifungals in patients with IC and increased length of hospital stay, health care costs, morbidity, and mortality.”
From Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting (2011) · cites this paper as [20]

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INAPPROPRIATE ANTIFUNGAL THERAPY FOR CANDIDEMIA AND HOSPITAL RESOURCE UTILIZATION
Zilberberg, M. D., Shorr, A. F., Kothari, S., Arnold, H. M., Micek, S. T., Labelle, A. J., & Kollef, M. H. (2009) · CHEST Journal · doi:10.1016/s0012-3692(16)47848-7
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Hospital Resource Utilization and Costs of Inappropriate Treatment of Candidemia
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Self-citation
Authors
Zilberberg, M. D., Kollef, M. H., Arnold, H., Labelle, A., Micek, S. T., Zilberberg, M. D., Kollef, M. H., Arnold, H., Labelle, A., Micek, S. T., et al. (2010)
Self-citation
Open Access
Zilberberg, M. D., Kollef, M. H., Arnold, H. M., Labelle, A. J., Micek, S. T., Kothari, S., & Shorr, A. F. (2013)
Self-citation
798
Contrael, K., Pack, J., Šunjić, I., Varkey, J. B., & Killian, A. J. (2013) · Critical Care Medicine · doi:10.1097/01.ccm.0000440036.36936.6c

Authors: Zilberberg, M. D., Kollef, M. H., Arnold, H., Labelle, A., Micek, S. T., Kothari, S., & Shorr, A. F.
Affiliations: Washington University in St. Louis (US)
Astellas Pharma (United States) (US)
MedStar Washington Hospital Center (US)
Corresponding author: Zilberberg, Marya D
ORCID: Zilberberg, Marya D
Kollef, Marin H
Kothari, Smita
Shorr, Andrew F
Venue: BMC Infectious Diseases
Publisher: Springer Science and Business Media LLC
Published: 2010-06-03
Volume: 10
Issue: 1
Pages: 150-150
ISSN: 1471-2334 (ISSN-L)
DOI: 10.1186/1471-2334-10-150
PMC: PMC2890008
OpenAlex: W2129412480
Cited by: 128
References: 19
Citations by year: 2026: 1 · 2025: 8 · 2024: 4 · 2023: 2 · 2022: 5 · 2021: 8 · 2020: 10 · 2019: 5 · 2018: 7 · 2017: 9 · 2016: 7 · 2015: 9 · 2014: 15 · 2013: 7 · 2012: 11
FWCI: 7.88
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/2.0 (tdm)
Locations: BMC Infectious Diseases (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Digital Commons@Becker (Washington University School of Medicine) (submittedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics: Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
Health Sciences › Medicine › Ophthalmology › Ocular Infections and Treatments
Keywords: candidemia, antifungal dosing, length of hospital stay, hospital costs, hospital resource utilization, intensive care unit, invasive fungal infections, mortality
MeSH terms: Adult, Aged, Antifungal Agents, Candidiasis, Female, Health Services Research, Hospitals, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Retrospective Studies, Cohort Studies, Fungemia, Treatment Outcome, Health Care Costs

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Inappropriate empiric antifungal therapy for candidemia in the ICU and hospital resource utilization: a retrospective cohort study

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