title: Burden of early-onset candidemia: analysis of culture-positive bloodstream infections from a large U.S. database.
abstract: OBJECTIVE
  : To characterize the epidemiology and burden of early-onset, nonnosocomial candidemia.
  
  
  METHODS
  : Retrospective review of Cardinal Health Outcomes Research Database, which comprises all acute care admissions at participating hospitals.
  
  
  METHODS
  : A total of 176 acute care hospitals.
  
  
  METHODS
  : All patients admitted from 2000 through 2005 who had early-onset bloodstream infection, defined as presence of both a positive blood culture drawn within 1 day before or within 48 hrs after hospital admission and an appropriate diagnostic code for infection.
  
  
  METHODS
  : None.
  
  
  RESULTS
  : To evaluate the impact of different pathogens on clinical and economic outcomes, we performed mixed-effect logistic and linear regression analyses and controlled for potential confounding factors. Of 64,307 early-onset bloodstream infections, 738 (1.2%) were positive for Candida. The rate of early-onset candidemia nearly doubled between 2000 and 2003 (p < .001) and then stabilized. Crude in-hospital mortality was higher for candidemia than for bacterial bloodstream infection (28.3% vs. 15.0%; p < .0001). Compared with patients with bacterial bloodstream infections, patients with candidemia were more likely to have been admitted within 30 days and to have been transferred from another healthcare facility. Compared with Gram-negative bacterial bloodstream infection and after controlling for other risk factors, candidemia was associated with increased mortality risk (odds ratio, 2.38; 95% confidence interval, 1.94-2.91; p < .0001), longer attributable hospital stay (4.8 days; 95% confidence interval, 4.1-5.5; p < .0001), and higher attributable hospital costs ($12,617; 95% confidence Interval, $10,755-$14,479; p < .0001).
  
  
  CONCLUSIONS
  : Early-onset candidemia seems to be a distinct entity, which is increasing in frequency and is associated with increased mortality risk, longer hospital stay, and higher hospital costs relative to bacterial bloodstream infection.
authors.affiliation: Pulmonary Critical Care, Washington Hospital Center, Potomac, MD, USA.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Shorr
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.forename: Xiaowu
authors.initials: X
authors.lastname: Sun
authors.forename: Richard S
authors.initials: RS
authors.lastname: Johannes
authors.forename: James
authors.initials: J
authors.lastname: Spalding
authors.forename: Ying P
authors.initials: YP
authors.lastname: Tabak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002177:Candidiasis / Q000097:blood / Q000453:epidemiology* / Q000382:microbiology; D016208:Databases, Factual; D005260:Female; D016469:Fungemia / Q000097:blood / Q000453:epidemiology* / Q000382:microbiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States