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Aspergillosis in Intensive Care Unit (ICU) patients: epidemiology and economic outcomes

BACKGROUND: Few data are available regarding the epidemiology of invasive aspergillosis (IA) in ICU patients. The aim of this study was to examine epidemiology and economic outcomes (length of stay, hospital costs) among ICU patients with IA who lack traditional risk factors for IA, such as cancer,...

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Autores principales: Baddley, John W, Stephens, Jennifer M, Ji, Xiang, Gao, Xin, Schlamm, Haran T, Tarallo, Miriam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3562254/
https://www.ncbi.nlm.nih.gov/pubmed/23343366
http://dx.doi.org/10.1186/1471-2334-13-29
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author Baddley, John W
Stephens, Jennifer M
Ji, Xiang
Gao, Xin
Schlamm, Haran T
Tarallo, Miriam
author_facet Baddley, John W
Stephens, Jennifer M
Ji, Xiang
Gao, Xin
Schlamm, Haran T
Tarallo, Miriam
author_sort Baddley, John W
collection PubMed
description BACKGROUND: Few data are available regarding the epidemiology of invasive aspergillosis (IA) in ICU patients. The aim of this study was to examine epidemiology and economic outcomes (length of stay, hospital costs) among ICU patients with IA who lack traditional risk factors for IA, such as cancer, transplants, neutropenia or HIV infection. METHODS: Retrospective cohort study using Premier Inc. Perspective™ US administrative hospital database (2005–2008). Adults with ICU stays and aspergillosis (ICD-9 117.3 plus 484.6) who received initial antifungal therapy (AF) in the ICU were included. Patients with traditional risk factors (cancer, transplant, neutropenia, HIV/AIDS) were excluded. The relationship of antifungal therapy and co-morbidities to economic outcomes were examined using Generalized linear models. RESULTS: From 6,424 aspergillosis patients in the database, 412 (6.4%) ICU patients with IA were identified. Mean age was 63.9 years and 53% were male. Frequent co-morbidities included steroid use (77%), acute respiratory failure (76%) and acute renal failure (41%). In-hospital mortality was 46%. The most frequently used AF was voriconazole (71% received at least once). Mean length of stay (LOS) was 26.9 days and mean total hospital cost was $76,235. Each 1 day lag before initiating AF therapy was associated with 1.28 days longer hospital stay and 3.5% increase in costs (p < 0.0001 for both). CONCLUSIONS: Invasive aspergillosis in ICU patients is associated with high mortality and hospital costs. Antifungal timing impacts economic outcomes. These findings underscore the importance of timely diagnosis, appropriate treatment, and consideration of Aspergillus as a potential etiology in ICU patients.
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spelling pubmed-35622542013-02-05 Aspergillosis in Intensive Care Unit (ICU) patients: epidemiology and economic outcomes Baddley, John W Stephens, Jennifer M Ji, Xiang Gao, Xin Schlamm, Haran T Tarallo, Miriam BMC Infect Dis Research Article BACKGROUND: Few data are available regarding the epidemiology of invasive aspergillosis (IA) in ICU patients. The aim of this study was to examine epidemiology and economic outcomes (length of stay, hospital costs) among ICU patients with IA who lack traditional risk factors for IA, such as cancer, transplants, neutropenia or HIV infection. METHODS: Retrospective cohort study using Premier Inc. Perspective™ US administrative hospital database (2005–2008). Adults with ICU stays and aspergillosis (ICD-9 117.3 plus 484.6) who received initial antifungal therapy (AF) in the ICU were included. Patients with traditional risk factors (cancer, transplant, neutropenia, HIV/AIDS) were excluded. The relationship of antifungal therapy and co-morbidities to economic outcomes were examined using Generalized linear models. RESULTS: From 6,424 aspergillosis patients in the database, 412 (6.4%) ICU patients with IA were identified. Mean age was 63.9 years and 53% were male. Frequent co-morbidities included steroid use (77%), acute respiratory failure (76%) and acute renal failure (41%). In-hospital mortality was 46%. The most frequently used AF was voriconazole (71% received at least once). Mean length of stay (LOS) was 26.9 days and mean total hospital cost was $76,235. Each 1 day lag before initiating AF therapy was associated with 1.28 days longer hospital stay and 3.5% increase in costs (p < 0.0001 for both). CONCLUSIONS: Invasive aspergillosis in ICU patients is associated with high mortality and hospital costs. Antifungal timing impacts economic outcomes. These findings underscore the importance of timely diagnosis, appropriate treatment, and consideration of Aspergillus as a potential etiology in ICU patients. BioMed Central 2013-01-23 /pmc/articles/PMC3562254/ /pubmed/23343366 http://dx.doi.org/10.1186/1471-2334-13-29 Text en Copyright ©2013 Baddley et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Baddley, John W
Stephens, Jennifer M
Ji, Xiang
Gao, Xin
Schlamm, Haran T
Tarallo, Miriam
Aspergillosis in Intensive Care Unit (ICU) patients: epidemiology and economic outcomes
title Aspergillosis in Intensive Care Unit (ICU) patients: epidemiology and economic outcomes
title_full Aspergillosis in Intensive Care Unit (ICU) patients: epidemiology and economic outcomes
title_fullStr Aspergillosis in Intensive Care Unit (ICU) patients: epidemiology and economic outcomes
title_full_unstemmed Aspergillosis in Intensive Care Unit (ICU) patients: epidemiology and economic outcomes
title_short Aspergillosis in Intensive Care Unit (ICU) patients: epidemiology and economic outcomes
title_sort aspergillosis in intensive care unit (icu) patients: epidemiology and economic outcomes
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3562254/
https://www.ncbi.nlm.nih.gov/pubmed/23343366
http://dx.doi.org/10.1186/1471-2334-13-29
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