Inappropriate Rx For Candidemia Can Be Costly

SAN DIEGO — Inappropriate antifungal therapy for candidemia in the ICU is the rule rather than the exception—and it leads to prolonged hospital length of stay and higher costs.

Of 90 consecutive patients with candidemia who required an ICU stay at Barnes-Jewish Hospital in St. Louis during 2004–2007, 80 patients (89%) received inappropriate antifungal therapy, defined as a treatment delay of more than 24 hours after onset of the bloodstream infection or inadequate dosing of a drug active against the pathogen, Dr. Marya D. Zilberberg said at the annual meeting of the American College of Chest Physicians.

In-hospital mortality occurred in 23 of the 80 recipients (29%) of inappropriate antifungal therapy and none of 10 patients whose candidemia was treated appropriately, reported Dr. Zilberberg of the University of Massachusetts, Amherst.

The mean hospital length of stay following culture-proven candidemia was 18.4 days with inappropriate antifungal therapy and 10.7 days with appropriate treatment. After adjustment for potential confounders, inappropriate antifungal therapy was associated with a mean $13,398 per patient in attributable excess costs and 7.7 extra days in the hospital.

The most common pathogens detected were Candida albicans, present in 58 of 90 patients; C. glabrata, present in 15; and C. parapsilosis, found in 10. Of all causative organisms, 80% were susceptible to fluconazole.

Disclosures: The study was funded by Astellas Pharma. Dr. Zilberberg is a consultant to Astellas and to Ortho-McNeil Janssen Scientific Affairs.