Title: Evaluation of candidemia prevalence and treatment cost comparison in a community-based hospital
Purpose: Candidemia is among the most common causes of nosocomial bloodstream infections in U.S. patients. It has been associated with high mortality rates and increased costs of care and duration of hospitalizations. The objective of this study is to evaluate the prevalence of candidemia in patients with risk factors as per the 2009 Infectious Diseases Society of America (IDSA) guidelines, to assess the appropriateness of therapy in patients with candidemia, and to compare the cost of fluconazole versus micafungin at initiation of therapy in our institution.
Methods: This is a single-centered, retrospective chart review of all inpatients with a diagnosis of candidemia, treated with either fluconazole or micafungin, from January 2010 to December 2014, and approved by our health care system’s Institutional Review Board. A laboratory department generated blood culture report will be used to identify candidemia patients. All patients under the age of 18 will be excluded from this study. Patient electronic medical records will be reviewed to evaluate the following based on 2009 IDSA guidelines: risk factors, illness severity, strain of Candida isolate (albicans versus non-albicans), appropriate use of fluconazole versus micafungin upon initiation of therapy, and appropriate duration of therapy. An overall cost comparison of fluconazole versus micafungin will be conducted. Cost of appropriate treatment versus inappropriate treatment used at start of therapy will be compared. Data will be analyzed using descriptive statistics.
Results: The prevalence of candidemia in our facility was predominately attributed to the use of implantable prosthetic devices, broad-spectrum antibiotics, and central venous catheters. On average, moderate to severely ill patients had a higher prevalence of candidemia. The most prevalent isolates were Candida albicans and parapsilosis. Of the 36.4% of patients that were inappropriately treated, one patient received antifungal therapy for 123 days and thus skewed our cost analysis. When assessing antifungal therapy, fluconazole and micafungin were inappropriately prescribed and dosed based on IDSA guidelines, at 40% and 20%; and at 25% and 2.5% respectively. The average length of treatment was 15 days.
Conclusions: The results of this study will be presented at our Antimicrobial Stewardship Committee and Pharmacy & Therapeutics Committee. We will be conducting an educational campaign with our healthcare providers in order to reinforce appropriate prescribing criteria for candidemia based on IDSA guidelines.
50th ASHP (American Society of Health-System Pharmacists) Midyear Clinical Meeting and Exhibition
Baptist Health South Florida Affiliations:
Bertha P. Rojas PharmD, Claudia Chng PharmD, BCPS, Frances Ordieres Gonzalez PharmD; South Miami Hospital
Rojas, Bertha P.; Chang, Claudia; and Ordieres Gonzalez, Frances, "Evaluation of candidemia prevalence and treatment cost comparison in a community-based hospital" (2015). All Publications. 959.
Available to all.