Treatment of candidemia with echinocandins: data on hospital resource use from a real world setting.
OBJECTIVE
Real-world data on patients treated with echinocandins for candidemia are limited. This study examined the effect of three echinocandin-based treatment regimens on resource utilization in patients with Candida infection.


METHODS
A retrospective cohort study of patients hospitalized between 2005 and 2010 with a blood culture positive for Candida. Length of stay (LOS) following AF initiation (post-AF LOS) and total days with AF treatment were compared in patients treated with three different echinocandin regimens: patients with echinocandin only, patients who received fluconazole prior to an echinocandin (fluconazole-echinocandin), and patients who received an echinocandin prior to fluconazole (echinocandin-fluconazole). Generalized linear models were used to adjust for confounders.


RESULTS
A total of 647 patients met inclusion criteria. Patients treated with echinocandin only were more acutely ill, having more organ dysfunction and sepsis. Unadjusted post-AF LOS was significantly greater in the groups that received both echinocandin and fluconazole (mean, 13.1 days for echinocandin-only vs 25.5 and 21.2 days for fluconazole-echinocandin and echinocandin-fluconazole groups, respectively, p<0.001). These groups also had a higher total number of days with AF orders. These differences remained after multivariate adjustment and in survivor-only analyses. Compared with echinocandin-only treatment, the average marginal effect of fluconazole-echinocandin and echinocandin-fluconazole regimens were associated with significantly longer adjusted post-AF LOS (by 7.2 days and 9.3 days, respectively, p<0.001) and significantly more adjusted total AF days (by 5.3 days for fluconazole-echinocandin and 6.5 days for echinocandin-fluconazole patients, p<0.001). Limitations included lack of visibility to specific reasons for therapy changes.


CONCLUSIONS
Fluconazole before or after echinocandin was associated with significantly greater resource utilization than echinocandin use alone.
Cerner LifeSciences, Culver City, CA 90230, USA. rolin.wade@cerner.com
Rolin L
RL
Wade
Paresh
P
Chaudhari
Rebecca S
RS
Campbell
Harlen D
HD
Hays
Brian H
BH
Nathanson
Jing
J
Yi
David
D
Horn
D000368:Aged; D000935:Antifungal Agents / Q000191:economics* / Q000627:therapeutic use; D058387:Candidemia / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D054714:Echinocandins / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D017722:Hospital Charges / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D012189:Retrospective Studies; D012720:Severity of Illness Index
D000935:Antifungal Agents; D054714:Echinocandins; D015725:Fluconazole