title: The epidemiology and attributable outcomes of candidemia in adults and children hospitalized in the United States: a propensity analysis.
abstract: 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 dollars (95% CI, 65,058 dollars-119,474 dollars). 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 dollars (95% CI, 33,604 dollars-45,602 dollars).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of General Pediatrics, The Children's Hospital of Philadelphia, PA 19104, USA. zaoutis@email.chop.edu
authors.forename: Theoklis E
authors.initials: TE
authors.lastname: Zaoutis
authors.forename: Jesse
authors.initials: J
authors.lastname: Argon
authors.forename: Jaclyn
authors.initials: J
authors.lastname: Chu
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Berlin
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walsh
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
mesh_terms: D000368:Aged; D002177:Candidiasis / Q000191:economics / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D005260:Female; D016469:Fungemia / Q000191:economics / Q000453:epidemiology*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States