Antifungal therapy and length of hospitalization in transplant patients with invasive aspergillosis.
The impact of antifungal therapy on economic outcomes in patients with invasive aspergillosis (IA) needs further exploration. The purpose of this study was to describe antifungal therapy and factors associated with hospital length of stay (LOS) in transplant patients with IA. Patients were enrolled from March 2001 to October 2005 and IA cases identified through March 2006 from a sub-group of patients in the Transplant Associated Infection Surveillance Network (TRANSNET). Factors associated with hospital LOS were determined by logistic regression analysis. Of 361 patients, the mean age was 49 years, 60.7% were male, and 63% were hematopoietic stem cell transplantation (HSCT) recipients. Primary monotherapy was used in 233 (64.5%) patients, of which voriconazole (93/233, 39.9%) was most commonly used antifungal. Primary combination therapy was used in 128 (35.4%) of 361 patients, with voriconazole plus caspofungin (81/361, 22.4%) the most frequently employed. Mean duration of therapy was 115 days (HSCT 109.7; solid organ transplant [SOT] 125.3). Mean hospital LOS was 35.3 days (HSCT 38.7; SOT 29.7). Regression analysis identified disseminated IA, neutropenia, malnutrition and length of ICU stay as factors associated with increased hospital LOS. Initial voriconazole use was associated with decreased LOS. Further investigation on impact of antifungal therapy on economic outcomes is needed.
Department of Medicine, University of Alabama at Birmingham and Birmingham VA Medical Center, Birmingham, Alabama 35294-0006, USA. jbaddley@uab.edu
John W
JW
Baddley
David R
DR
Andes
Kieren A
KA
Marr
Carol A
CA
Kauffman
Dimitrios P
DP
Kontoyiannis
James I
JI
Ito
Mindy G
MG
Schuster
Kyle D
KD
Brizendine
Thomas F
TF
Patterson
G Marshall
GM
Lyon
Michael
M
Boeckh
Robert A
RA
Oster
Tom
T
Chiller
Peter G
PG
Pappas
D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D001230:Aspergillus / Q000187:drug effects*; D000077336:Caspofungin; D015331:Cohort Studies; D003710:Demography; D004359:Drug Therapy, Combination; D054714:Echinocandins / Q000627:therapeutic use*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D017053:Infection Control; D007902:Length of Stay; D055666:Lipopeptides; D008168:Lung / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D011743:Pyrimidines / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013997:Time Factors; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D011743:Pyrimidines; D014230:Triazoles; D000077336:Caspofungin; D065819:Voriconazole