title: Epidemiology and cost implications of candidemia, a 6-year analysis from a developing country.
abstract: Surveillance of candidemia is essential to monitor trends in species distribution and change in the incidence and antifungal resistance. In this study, we aimed to investigate prevalence, resistance rates, antifungal utilization and costs. A 6-year retrospective analysis of the data belonging to patients with candidemia hospitalized between 2010 and 2016 was performed. The annual usage of fluconazole and caspofungin and the usage of these antifungals in different units were described in defined daily doses (DDD) per 1000 patient days. In total, 351 patients of candidemia were included. Median age of the patients was 45 (0-88) and 55.1% of them were male. Overall, 48.1% of the candidemia episodes (169/351) were due to C. albicans, followed by C. parapsilosis (25.1%), C. glabrata (11.7%). Length of hospital stay was longer with a median of 20 days among patients with non-albicans candidemia. Presence of a central venous catheter was found to be an associated risk for candidemia caused by non-albicans strains. Annual incidence of candidemia increased from 0.10 to 0.30 cases/1000 patient days. Antifungal use was increased over years correlated with the cost paid for it. The policy against candidemia should be specified by each institution with respect to candidemia prevalence, resistance rates, antifungal use and costs.
authors.affiliation: Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
authors.forename: Aysegul
authors.initials: A
authors.lastname: Ulu Kilic
authors.affiliation: Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
authors.forename: Emine
authors.initials: E
authors.lastname: Alp
authors.affiliation: Infection Control Committee, Faculty of Medicine, Fatma Cevahir Erciyes University, Kayseri, Turkey.
authors.forename: Fatma
authors.initials: F
authors.lastname: Cevahir
authors.affiliation: Department of Infectious Diseases, Faculty of Medicine, Zeynep Türe Erciyes University, Kayseri, Turkey.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Ture
authors.affiliation: Department of Pharmacy, Faculty of Medicine, Nuran Yozgat Erciyes University, Kayseri, Turkey.
authors.forename: Nuran
authors.initials: N
authors.lastname: Yozgat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000187:drug effects / Q000302:isolation & purification*; D002176:Candida albicans / Q000187:drug effects; D041221:Candida glabrata / Q000187:drug effects; D058387:Candidemia / Q000191:economics* / Q000453:epidemiology* / Q000382:microbiology; D000077336:Caspofungin; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D003906:Developing Countries / Q000706:statistics & numerical data*; D054714:Echinocandins / Q000627:therapeutic use; D062665:Epidemiological Monitoring; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D055666:Lipopeptides / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D013997:Time Factors; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D015725:Fluconazole; D000077336:Caspofungin
keywords: candida; candidemia; cost; defined daily doses; developing country