Objectives: To provide a picture of local epidemiology and to assess whether appropriate antifungal therapy is administered in a timely fashion. To evaluate risk factors, outcome and the associated costs. Methods: Retrospective analysis of all candidaemias between January 2005 and December 2010 at a 460 bed district general hospital. Results: There were a total of 60 candidaemias between 2005-2010 resulting in a prevalence of 0.24 per 1000 patient admissions. The most predominant species were C. albicans which accounted for 43 cases (73%). From a total of 60 candidaemias, 55 cases were investigated further. It was found that 56% of cases were diagnosed in intensive care (ITU) resulting in ITU prevalence of 9.4 per 1000 admissions compared to a non ITU prevalence of 0.10 per 1000 admissions. This equates to approximately a 100-fold difference between ITU and non ITU cases, consistent with previous reports. The most common risk factor was a central venous pressure line (67%). Forty out of 45 (88.9%) patients received appropriate antifungal treatment within 24 hours of positive blood culture. From a total of 54 candidaemias, crude mortality rate was 36.6% (15/ 41) and 46.2% (6/13) for C. albicans and non-albicans Candida respectively. The difference between the crude mortality is 9.6% and is not significant (p = 0.75, Fisher’s exact test). Hospitalization plus antifungal costs were ≤48 698/pt and ≤67 809/pt for the C. albicans and non-albicans Candida groups respectively. The average length of stay per patient was 58 bed days however, the C. albicans group accounted for 18.6 bed days/pt in ITU and 34.5 bed days/pt in non ITU wards, compared to the non-albicans Candida group who accounted for 23.8 bed days/pt in ITU and 50.7 bed days/pt in non ITU wards. Conclusions: 88.9% of patients received timely antifungal treatment. There is a high mortality rate in patients with candidaemias. The care of C. albicans infections was on average ≤19 111/pt cheaper. Trust outcome would be to devise and implement a candidaemia score card to improve outcomes and costs.
Full conference title:
22nd European Congress of Clinical Microbiology and Infectious Diseases
- ECCMID 22nd (2012)