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1708. Epidemiology of Coccidioidomycosis-Associated Hospitalizations and In-hospital Deaths, California, 2000–2017
BACKGROUND: Coccidioidomycosis (CM) is caused by inhalation of spores of the soil-dwelling Coccidioides spp. fungus; infection can lead to severe respiratory or disseminated disease. In California, reported cases increased 222% since 2014 (2,316 cases) peaking in 2017 with 7,466 cases (rate 18.1/100...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6811189/ http://dx.doi.org/10.1093/ofid/ofz360.2512 |
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author | Sondermeyer Cooksey, Gail L Kamali, Amanda Vugia, Duc Jain, Seema |
author_facet | Sondermeyer Cooksey, Gail L Kamali, Amanda Vugia, Duc Jain, Seema |
author_sort | Sondermeyer Cooksey, Gail L |
collection | PubMed |
description | BACKGROUND: Coccidioidomycosis (CM) is caused by inhalation of spores of the soil-dwelling Coccidioides spp. fungus; infection can lead to severe respiratory or disseminated disease. In California, reported cases increased 222% since 2014 (2,316 cases) peaking in 2017 with 7,466 cases (rate 18.1/100,000 population), the highest annual reported cases on record. We reviewed the California hospital CM data to describe trends, demographics, comorbidities, and risk factors for in-hospital death. METHODS: Using 2000–2017 California administrative hospital discharge data, we identified hospitalizations with ≥1 CM-associated International Classification of Diseases, Ninth or Tenth diagnosis code. We calculated incidence rates per 100,000 population, assessed trends by negative binomial regression, and compared patient characteristics for potential risk factors for in-hospital death by calculating age-adjusted odds ratios (aOR) using bivariate logistic regression (significance, P < 0.05). RESULTS: From 2000 to 2017, 25,372 patients were hospitalized with a CM discharge code in California, and hospitalization rates increased significantly from 2.3 to 5.8/100,000 population (P < 0.01) (Figure 1). Most patients were male (69%), >40 years old (69%), white (40%) or Hispanic (38%), and residents of the higher incidence CM regions in California (52%). Most (83%) were not immunocompromised; only 3% had a human immunodeficiency virus (HIV) diagnosis. A total of 1,951 (8%) patients died in-hospital with more deaths among those with disseminated CM (15%), particularly meningitis (17%), than with pulmonary disease (7%). Frequency of death increased with increasing age (0–19 years [2%], 20–39 years [5%], 40–59 years [7%], 60+ years [13%]). Odds of in-hospital death was highest among patients with HIV (aOR 6.4, 95% CI 5.3–7.7) or chronic kidney disease (aOR 2.6, 95% CI 2.3–2.8) (Figure 2). CONCLUSION: CM-associated hospitalization rates have increased in California in the last 18 years, peaking in 2017, with 1 in 12 patients dying in-hospital. Risk factors for death include disseminated CM, older age, HIV infection, and chronic kidney disease. Clinicians should be aware of these risks in caring for patients hospitalized with CM. [Image: see text] [Image: see text] DISCLOSURES: All Authors: No reported disclosures. |
format | Online Article Text |
id | pubmed-6811189 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-68111892019-10-29 1708. Epidemiology of Coccidioidomycosis-Associated Hospitalizations and In-hospital Deaths, California, 2000–2017 Sondermeyer Cooksey, Gail L Kamali, Amanda Vugia, Duc Jain, Seema Open Forum Infect Dis Abstracts BACKGROUND: Coccidioidomycosis (CM) is caused by inhalation of spores of the soil-dwelling Coccidioides spp. fungus; infection can lead to severe respiratory or disseminated disease. In California, reported cases increased 222% since 2014 (2,316 cases) peaking in 2017 with 7,466 cases (rate 18.1/100,000 population), the highest annual reported cases on record. We reviewed the California hospital CM data to describe trends, demographics, comorbidities, and risk factors for in-hospital death. METHODS: Using 2000–2017 California administrative hospital discharge data, we identified hospitalizations with ≥1 CM-associated International Classification of Diseases, Ninth or Tenth diagnosis code. We calculated incidence rates per 100,000 population, assessed trends by negative binomial regression, and compared patient characteristics for potential risk factors for in-hospital death by calculating age-adjusted odds ratios (aOR) using bivariate logistic regression (significance, P < 0.05). RESULTS: From 2000 to 2017, 25,372 patients were hospitalized with a CM discharge code in California, and hospitalization rates increased significantly from 2.3 to 5.8/100,000 population (P < 0.01) (Figure 1). Most patients were male (69%), >40 years old (69%), white (40%) or Hispanic (38%), and residents of the higher incidence CM regions in California (52%). Most (83%) were not immunocompromised; only 3% had a human immunodeficiency virus (HIV) diagnosis. A total of 1,951 (8%) patients died in-hospital with more deaths among those with disseminated CM (15%), particularly meningitis (17%), than with pulmonary disease (7%). Frequency of death increased with increasing age (0–19 years [2%], 20–39 years [5%], 40–59 years [7%], 60+ years [13%]). Odds of in-hospital death was highest among patients with HIV (aOR 6.4, 95% CI 5.3–7.7) or chronic kidney disease (aOR 2.6, 95% CI 2.3–2.8) (Figure 2). CONCLUSION: CM-associated hospitalization rates have increased in California in the last 18 years, peaking in 2017, with 1 in 12 patients dying in-hospital. Risk factors for death include disseminated CM, older age, HIV infection, and chronic kidney disease. Clinicians should be aware of these risks in caring for patients hospitalized with CM. [Image: see text] [Image: see text] DISCLOSURES: All Authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6811189/ http://dx.doi.org/10.1093/ofid/ofz360.2512 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Abstracts Sondermeyer Cooksey, Gail L Kamali, Amanda Vugia, Duc Jain, Seema 1708. Epidemiology of Coccidioidomycosis-Associated Hospitalizations and In-hospital Deaths, California, 2000–2017 |
title | 1708. Epidemiology of Coccidioidomycosis-Associated Hospitalizations and In-hospital Deaths, California, 2000–2017 |
title_full | 1708. Epidemiology of Coccidioidomycosis-Associated Hospitalizations and In-hospital Deaths, California, 2000–2017 |
title_fullStr | 1708. Epidemiology of Coccidioidomycosis-Associated Hospitalizations and In-hospital Deaths, California, 2000–2017 |
title_full_unstemmed | 1708. Epidemiology of Coccidioidomycosis-Associated Hospitalizations and In-hospital Deaths, California, 2000–2017 |
title_short | 1708. Epidemiology of Coccidioidomycosis-Associated Hospitalizations and In-hospital Deaths, California, 2000–2017 |
title_sort | 1708. epidemiology of coccidioidomycosis-associated hospitalizations and in-hospital deaths, california, 2000–2017 |
topic | Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6811189/ http://dx.doi.org/10.1093/ofid/ofz360.2512 |
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