Burden of early-onset candidemia: Analysis of culture-positive bloodstream infections from a large US database

Objectives: To characterize the epidemiology and burden of early-onset nonnosocomial candidemia. Design: Retrospective review of Cardinal Health Outcomes Research Database, which comprises all acute care admissions at participating hospitals. Setting: A total of 176 acute care hospitals. Patients. All patients admitted from 2000 through 2005 who had early-onset bloodstream infection, defined as presence of both a positive blood culture drawn within 1 day before or within 48 hrs after hospital admission and an appropriate diagnostic code for infection. Intervention: None. Measurements and Main Results: To evaluate the impact of different pathogens on clinical and economic outcomes, we performed mixed-effect logistic and linear regression analyses and controlled for potential confounding factors. Of 64,307 early-onset bloodstream infections, 738 (1.2%) were positive for Candida The rate of early-onset candidemia nearly doubled between 2000 and 2003 (p < .001) and then stabilized. Crude in-hospital mortality was higher for candidemia than for bacterial bloodstream infection (283% vs. 15.0%; p < .0001). Compared with patents with bacterial bloodstream infections, patents with candidemia were more likely to have been admitted within 30 days and to have been transferred from another health-care facility. Compared with Gram-negative bacterial bloodstream infection and after controlling for other risk factors, candidemia was associated with increased mortality risk (odds ratio, 2.38; 95% confidence interval, 1.94-2.91; p < .0001), longer attributable hospital stay (4.8 days; 95% confidence interval, 4.1-5.5; p < .0001), and higher attributable hospital costs ($12,617; 95% confidence Interval, $10,755-$14,479; p < .0001). Conclusions: Eady-onset candidemia seems to be a distinct entity, which is increasing in frequency and is associated with increased mortality risk longer hospital stay, and higher hospital costs relative to bacterial bloodstream infection. (Crit Care Med 2009; 37:2519-2526)