Candida Infections: Outcome and Attributable ICU Costs in Critically Ill Patients

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Abstract
Candida species are an increasingly common cause of nosocomial infections. Candida infections have been associated with significant attributable morbidity and mortality, especially among critically ill patients. However, little is known about the cost implications of these increasingly common infections. In order to evaluate the costs associated with Candida infections in the critically ill, we report the findings of a 3–month prospective cohort study of Candida infections in the medical intensive care unit (MICU) and the surgical intensive care unit (SICU) at Johns Hopkins Hospital. Infections were diagnosed according to prospectively established definitions. Cost data were extracted from the computerized billing database and used to estimate the ICU costs associated with nosocomial Candida infection. Using multiple linear regression, the effect of Candida infections on cost was adjusted for clinical variables in order to estimate the cost of ICU care attributable to Candida infection. Of 117 ICU patients enrolled in the study, 14 developed Candida infections. In a stepwise linear regression model adjusting for multiple clinical variables including APACHE II score, infection with Candida species was associated with an attributable ICU cost of $21,590. Over the cohort, the increased cost associated with Candida infections translates into a cost of $230/ICU patient-day. In addition, Candida infections were associated with an increased length of hospital stay of 17 days and an increased length of ICU stay of 8 days. In this small, prospective, cohort study, nosocomial Candida infections are independently associated with an increase in the cost of ICU care and an increased length of stay. No increase in mortality was noted, though it is possible a difference in mortality was missed due to the study's small sample size.