Excess mortality, hospital stay, and cost due to candidemia: a case-control study using data from population-based candidemia surveillance.
OBJECTIVE
To determine the mortality, hospital stay, and total hospital charges and cost of hospitalization attributable to candidemia by comparing patients with candidemia with control-patients who have otherwise similar illnesses. Prior studies lack broad patient and hospital representation or cost-related information that accurately reflects current medical practices.


METHODS
Our case-control study included case-patients with candidemia and their cost-related data, ascertained from laboratory-based candidemia surveillance conducted among all residents of Connecticut and Baltimore and Baltimore County, Maryland, during 1998 to 2000. Control-patients were matched on age, hospital type, admission year, discharge diagnoses, and duration of hospitalization prior to candidemia onset.


RESULTS
We identified 214 and 529 sets of matched case-patients and control-patients from the two locations, respectively. Mortality attributable to candidemia ranged between 19% and 24%. On multivariable analysis, candidemia was associated with mortality (OR, 5.3 for Connecticut and 8.5 for Baltimore and Baltimore County; P < .05), whereas receiving adequate treatment was protective (OR, 0.5 and 0.4 for the two locations, respectively; P < .05). Candidemia itself did not increase the total hospital charges and cost of hospitalization; when treatment status was accounted for, having received adequate treatment for candidemia significantly increased the total hospital charges and cost of hospitalization ($6,000 to $29,000 and $3,000 to $22,000, respectively) and the length of stay (3 to 13 days).


CONCLUSIONS
Our findings underscore the burden of candidemia, particularly regarding the risk of death, length of hospitalization, and cost associated with treatment.
Morgan
Juliette
J
Centers for Disease Control and Prevention, Atlanta, Georgia, USA. JMorgan1@cdc.gov
Meltzer
Martin I
MI
Plikaytis
Brian D
BD
Sofair
Andre N
AN
Huie-White
Sharon
S
Wilcox
Steven
S
Harrison
Lee H
LH
Seaberg
Eric C
EC
Hajjeh
Rana A
RA
Teutsch
Steven M
SM
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D015142:Baltimore / Q000453:epidemiology; D002177:Candidiasis / Q000191:economics / Q000401:mortality; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003237:Connecticut / Q000453:epidemiology; D017281:Cost of Illness; D003428:Cross Infection / Q000191:economics / Q000401:mortality; D005260:Female; D016469:Fungemia / Q000191:economics / Q000401:mortality; D017722:Hospital Charges / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000191:economics*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011159:Population Surveillance