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Economic Impact of Candida Colonization and Candida Infection in the Critically Ill Patient

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Abstract

The objective of the study presented here was to assess the economic impact of Candida colonization and Candida infection in critically ill patients admitted to intensive care units (ICUs). For this purpose, a prospective, cohort, observational, and multicenter study was designed. A total of 1,765 patients over the age of 18 years who were admitted for at least 7 days to 73 medical-surgical ICUs in 70 Spanish hospitals between May 1998 and January 1999 were studied. From day 7 of ICU admission to ICU discharge, samples of tracheal aspirates, pharyngeal exudates, gastric aspirates and urine were collected every week for culture. Prolonged length of stay was associated with severity of illness, Candida colonization or infection, infection by other fungi, antifungal therapy, treatment with more than one antifungal agent, and toxicity associated with this therapy. Compared to non-colonized, non-infected patients (n=720), patients with Candida colonization (n=880) had an extended ICU stay of 6.2 days (OR, 1.69; 95%CI, 1.53–1.87; P<0.001) and an extended hospital stay of 8.6 days (OR, 1.27; 95%CI, 1.16–1.40; P<0.001). The corresponding figures for patients with Candida infection (n=105) were 12.7 days for ICU stay (OR, 2.13; 95%CI, 1.72–2.64; P<0.001) and 15.5 days for hospital stay (OR, 1.23; 95%CI, 0.99–1.52; P=0.060). Candida colonization resulted in an additional 8,000 EUR in direct costs and Candida infection almost 16,000 EUR. Both Candida colonization and Candida infection had an important economic impact in terms of cost increases due to longer stays in both the ICU and in the hospital.

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Acknowledgements

We thank Gilead Sciences, S.L., for financial support with the logistic aspects of the study and M. Pulido for editorial assistance.

EPCAN Study Group: J. Nolla, F. Álvarez-Lerma, M Salvadó (Hospital del Mar, Barcelona); N. Carrasco, A. Bueno (Hospital de la Princesa, Madrid); F. Bobillo, P. Ucio (Hospital Clínico, Valladolid); M.A. León, M. Nolla, R.A. Díaz (Hospital General de Catalunya, Barcelona); J.R. Iruretagoyena, K. Esnaola, I. Andetxaga (Hospital de Cruces, Bilbao); A. Blanco, F. Taboada, R. Fernández (Hospital Nuestra Señora de Covadonga, Oviedo); M. Nieto, R. Diego, F. Ortuño(Hospital Clínico San Carlos, Madrid); P. Marcos, E. Mesalles (Hospital Germans Trias i Pujol, Badalona, Barcelona); A. Martínez, M. Fernández, F. Jaime (Hospital Virgen de la Arrixaca, Murcia); H. Sancho, N. Izquierdo (Hospital Reina Sofía, Córdoba); M. Ulibarrena, F. Labayen (Hospital Santiago Apóstol, Vitoria); F. Barcenilla, M.J. Gil, B. Balsera (Hospital Arnau de Villanova, Lleida); R. Jordá, M. Jurado, J. Pérez (Hospital Son Dureta, Palma de Mallorca); E. Zavala, A. Alcón, N. Fabregues (Hospital Clínic i Provincial, Barcelona); M.V. de la Torre, M.A. Estecha, A. Soler (Hospital Virgen de la Victoria, Málaga); M. Bodí, D. Castander (Hospital Joan XXIII, Tarragona); A. Mendía, J. Artaetxebarría, C. Reviejo (Hospital Nuestra Señora de Aránzazu, San Sebastián); M. Sánchez, A. Casamitjana, C. Pérez (Hospital Insular, Las Palmas de Gran Canaria); M.J. López, E. Robles (Hospital General de Segovia, Segovia); Y. Insausti, J.A. Tihistsa (Hospital de Navarra, Pamplona); C. García, J.M. Rubio (Hospital 12 de Octubre, Madrid); R. Oltra, O. Rodríguez (Hospital Clínico Universitario, Valencia); P. Olaechea, R. de Celís (Hospital de Galdakao, Bizkaia); J.M. Soto, J. Pomares (Hospital San Cecilio, Granada); J. Luna, G. Masdeu (Hospital Virgen de la Cinta, Tarragona); R. Sierra, A. Gordillo (Hospital Puerta del Mar, Cádiz); R. Rodríguez, J. Fajardo (Hospital Virgen de la Macarena, Sevilla); M.A. Herranz, J.I. Gómez (Hospital Río Hortega, Valladolid); R.M. García, M.J. Espina (Hospital de Cabueñes, Gijón); J. Garnacho, C. Ortiz (Hospital Virgen del Rocío, Sevilla); M. Palomar, J. Montero J (Hospital Vall d’Hebron, Barcelona); C. Cisneros, A. Sandiumenje (UCI de Traumatología, Hospital 12 de Octubre, Madrid); M. Sánchez, M. Álvarez (Hospital Príncipe de Asturias, Madrid); V. López, R. Julve (Hospital de Sagunto, Valencia); J. Solé, M. Valerón (Hospital Nuestra Señora del Pino, Las Palmas de Gran Canaria); M.A. Blasco, S. Borrás (Hospital Dr. Peset, Valencia); E. Maraví, J.M. Urtasun (Hospital Virgen del Camino, Pamplona); C. Sánchez-Díaz (Hospital San Pedro de Alcántara, Cáceres); L.M. Tamayo (Hospital Río Carrión, Palencia); J. Blanco (Complexo Hospitalario Xeral-Calde, Lugo); P. Galdós (Hospital General de Móstoles, Madrid); F. Barredo (Hospital de Torrecárdenas, Almería); A. Rodríguez (Hospital Santa María del Rosell, Cartagena); J. Castaño (Hospital Virgen de las Nieves, Granada); A. Bonet (Hospital Josep Trueta, Girona); M. Cerdá (Hospital de la Creu Roja, L’Hospitalet de Llobregat, Barcelona); A. Torres (UVIR, Hospital Clínic i Provincial, Barcelona); F. Pérez F (Fundación Jiménez Díaz, Madrid); J.M. Flores (UCI Traumatología, Hospital Virgen del Rocío, Sevilla); R. Diego (Hospital General Universitario, Valencia); C. Fernández (Complejo Hospitalario Insalud, León); A. Mas (Centre Hospitalari i Cardiologic, Manresa, Barcelona); F. Ruiz (Hospital Ciudad de Jaén, Jaén); C. León, (Hospital Nuestra Señora de Valme, Sevilla); M. Casanovas (Hospital de Igualada, Igualada, Barcelona); E.A. Sanz (Hospital Santa Ana, Motril, Granada); J.A. Artola (Hospital Naval de San Carlos, Cádiz); M.P. Luque (UCI de Traumatología, Hospital Clínico Univresitario, Zaragoza); C. Palazón (Hospital General Universitario, Murcia); C. Sotillo (Hospital Gregorio Marañón, Madrid); A. Bisbal (Policlínica Miramar, Palma de Mallorca); M.J. Huertos (Hospital de Puerto Real, Cádiz); F. Esteban (Hospital Sant Joan de Reus, Reus, Tarragona); P. Ugarte (Hospital Marqués de Valdecilla, Santander); R. Giral (Hospital General Yagüe, Burgos); V. González (Hospital Miguel Servet, Zaragoza); M.J. Serralta (Hospital San Juan, Alicante); A. Cercas (Hospital de Jerez, Cádiz); A. Nebra (Hospital Clínico Universitario, Zaragoza); C. Castillo (Hospital Txagorritxu, Vitoria-Gasteiz); A. Cercas (Hospital de Jerez, Cádiz); A. Nebra (Hospital Clínico Universitario, Zaragoza); C. Castillo (Hospital Txagorritxu, Vitoria), A. Tejada (UCI Traumatología, Hospital Miguel Servet, Zaragoza); and J.I. Gómez (REA, Hospital Río Ortega, Valladolid), Spain.

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Authors and Affiliations

  1. Emergency Service and Intensive Care Medicine, Hospital de Galdakao, Bº de Labeaga s/n, 48960, Galdakao, Bizkaia, Spain

    P. M. Olaechea

  2. Service of Intensive Care Medicine, Hospital Vall d’Hebron, Barcelona, Spain

    M. Palomar

  3. Service of Intensive Medicine, Hospital de Valme, Sevilla, Spain

    C. León-Gil

  4. Service of Intensive Care Medicine, Hospital Universitari del Mar, Barcelona, Spain

    F. Álvarez-Lerma & J. Nolla-Salas

  5. Service of Intensive Care Medicine, Hospital Son Dureta, Palma de Mallorca, Spain

    R. Jordá

  6. Intensive Care Unit, Hospital de Barcelona, Barcelona, Spain

    M. A. León-Regidor

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  1. P. M. Olaechea
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  2. M. Palomar
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  3. C. León-Gil
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  4. F. Álvarez-Lerma
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  6. J. Nolla-Salas
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  7. M. A. León-Regidor
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Correspondence to P. M. Olaechea.

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Olaechea, P.M., Palomar, M., León-Gil, C. et al. Economic Impact of Candida Colonization and Candida Infection in the Critically Ill Patient. Eur J Clin Microbiol Infect Dis 23, 323–330 (2004). https://doi.org/10.1007/s10096-004-1104-x

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