title: Attributable costs of patients with candidemia and potential implications of polymerase chain reaction-based pathogen detection on antifungal therapy in patients with sepsis.
abstract: OBJECTIVE
  The purposes of this study were to calculate attributable costs of candidemia in patients with severe sepsis and to obtain preliminary data regarding the potential effects of polymerase chain reaction-based pathogen detection on antifungal therapy for these patients.
  
  
  METHODS
  Patients treated between 2004 and 2010 because of severe sepsis were included into this retrospective analysis. The hospital management provided annual fixed costs per patient-day; data for variable intensive care unit costs were taken from the literature. Multiplex polymerase chain reaction (PCR) was used (VYOO, SIRS-Lab, Jena, Germany) for pathogen detection in the blood.
  
  
  RESULTS
  Thirty-two patients with candidemia were identified. Of 874 patients with sepsis, propensity score matching found 32 corresponding patients with sepsis but without candida infection but similar risk factors for developing candidemia. Attributable costs of candidemia were 7713.79 Euro (cost increase, 19.4%). Initiation of antifungal therapy was reduced from 67.5 (52.4, 90) hours in the group, where candida infection was determined by blood culture, to 31.0 (28.0, 37.5; P < .01) hours after detection by multiplex PCR.
  
  
  CONCLUSIONS
  Candidemia increases costs of care in patients with septic shock. Polymerase chain reaction-based pathogen detection significantly reduces the time to initiation of antifungal therapy. This might impact on the clinical course of the disease but need to be confirmed in further trials.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany. frank.bloos@med.uni-jena.de
authors.forename: Frank
authors.initials: F
authors.lastname: Bloos
authors.forename: Ole
authors.initials: O
authors.lastname: Bayer
authors.forename: Svea
authors.initials: S
authors.lastname: Sachse
authors.forename: Eberhard
authors.initials: E
authors.lastname: Straube
authors.forename: Konrad
authors.initials: K
authors.lastname: Reinhart
authors.forename: Andreas
authors.initials: A
authors.lastname: Kortgen
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000191:economics*; D058387:Candidemia / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D016022:Case-Control Studies; D003365:Costs and Cost Analysis; D057210:Delayed Diagnosis / Q000191:economics / Q000517:prevention & control*; D005260:Female; D005858:Germany; D017048:Health Care Costs; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D016015:Logistic Models; D008297:Male; D016555:Matched-Pair Analysis; D060885:Multiplex Polymerase Chain Reaction / Q000191:economics*; D057216:Propensity Score; D012189:Retrospective Studies; D012772:Shock, Septic / Q000188:drug therapy / Q000191:economics / Q000382:microbiology; D013997:Time Factors
chemical_list: D000935:Antifungal Agents