caa a22 4500 606157727 CHVBK 20210128100615.0 cr unu---uuuuu 210128e20150201xx s 000 0 eng 10.1007/s10096-014-2230-8 doi (NATIONALLICENCE)springer-10.1007/s10096-014-2230-8 Candidemia in the intensive care unit: analysis of direct treatment costs and clinical outcome in patients treated with echinocandins or fluconazole [Elektronische Daten] [S. Heimann, O. Cornely, H. Wisplinghoff, M. Kochanek, D. Stippel, S. Padosch, G. Langebartels, H. Reuter, M. Reiner, A. Vierzig, H. Seifert, M. Vehreschild, J. Glossmann, B. Franke, J. Vehreschild] Direct treatment costs caused by candidemia in German intensive care unit (ICU) patients are currently unknown. We analyzed treatment costs and the impact of antifungal drug choice. Comprehensive data of patients who had at least one episode of candidemia while staying in the ICU between 01/2005 and 12/2010 were documented in a database using the technology of the Cologne Cohort of Neutropenic Patients (CoCoNut). A detailed analysis of all disease-associated treatment costs was performed. Patients treated with echinocandins (i.e., anidulafungin, caspofungin, micafungin) or fluconazole were analyzed separately and compared. Forty-one and 64 patients received echinocandins and fluconazole, respectively. The mean Acute Physiology and Chronic Health Evaluation (APACHE) IV score was 114 (95 % confidence interval [CI]: 106-122) vs. 95 (95 % CI: 90-101, p = <0.001). Twenty-three (56%) and 33 (52%, p = 0.448) patients survived hospitalization, while 17 (41%) and 22 (34%, p = 0.574) survived one year after diagnosis. In the echinocandin and fluconazole groups, the mean costs per patient of ICU treatment were €20,338 (95 % CI: €12,893-27,883) vs. €11,932 (95 % CI: €8,016-15,849, p = 0.110), and the total direct treatment costs per patient were €37,995 (95 % CI: €26,614-€49,376) vs. €22,305 (95 % CI: €16,817-€27,793, p = 0.012), resulting in daily costs per patient of €1,158 (95 % CI: €1,036-€1,280) vs. €927 (95 % CI: €828-€1,026, p = 0.001). Our health economic analysis shows the high treatment costs of patients with candidemia in the ICU. Sicker patients had a prolonged hospitalization and were more likely to receive echinocandins, leading to higher treatment costs. Outcomes were comparable to those achieved in less sick patients with fluconazole. Springer-Verlag Berlin Heidelberg, 2014 Heimann S. 1st Department of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany aut Cornely O. 1st Department of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany aut Wisplinghoff H. Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Goldenfelsstraße 19-21, 50935, Cologne, Germany aut Kochanek M. 1st Department of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany aut Stippel D. Department of General, Visceral and Cancer Surgery, University of Cologne, 50924, Cologne, Germany aut Padosch S. Department of Anaesthesiology and Postoperative Intensive Care Medicine, University of Cologne, 50924, Cologne, Germany aut Langebartels G. Department for Cardiothoracic Surgery, Heart Center of the University of Cologne, Kerpener Str. 62, 50924, Cologne, Germany aut Reuter H. Department of Internal Medicine III, University Hospital of Cologne, 50924, Cologne, Germany aut Reiner M. Department of Neurosurgery, University Hospital Cologne, 50924, Cologne, Germany aut Vierzig A. Department of Neonatology and Pediatric Intensive Care, Childrens's Hospital, University of Cologne, 50924, Cologne, Germany aut Seifert H. German Centre for Infection Research, partner site Bonn-Cologne, Cologne, Germany aut Vehreschild M. 1st Department of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany aut Glossmann J. 1st Department of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany aut Franke B. 1st Department of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany aut Vehreschild J. 1st Department of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany aut European Journal of Clinical Microbiology & Infectious Diseases Springer Berlin Heidelberg 34/2(2015-02-01), 331-338 0934-9723 34:2<331 2015 34 10096 https://doi.org/10.1007/s10096-014-2230-8 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10096-014-2230-8 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Heimann S. 1st Department of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany aut NATIONALLICENCE 700 1- Cornely O. 1st Department of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany aut NATIONALLICENCE 700 1- Wisplinghoff H. Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Goldenfelsstraße 19-21, 50935, Cologne, Germany aut NATIONALLICENCE 700 1- Kochanek M. 1st Department of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany aut NATIONALLICENCE 700 1- Stippel D. Department of General, Visceral and Cancer Surgery, University of Cologne, 50924, Cologne, Germany aut NATIONALLICENCE 700 1- Padosch S. Department of Anaesthesiology and Postoperative Intensive Care Medicine, University of Cologne, 50924, Cologne, Germany aut NATIONALLICENCE 700 1- Langebartels G. Department for Cardiothoracic Surgery, Heart Center of the University of Cologne, Kerpener Str. 62, 50924, Cologne, Germany aut NATIONALLICENCE 700 1- Reuter H. Department of Internal Medicine III, University Hospital of Cologne, 50924, Cologne, Germany aut NATIONALLICENCE 700 1- Reiner M. Department of Neurosurgery, University Hospital Cologne, 50924, Cologne, Germany aut NATIONALLICENCE 700 1- Vierzig A. Department of Neonatology and Pediatric Intensive Care, Childrens's Hospital, University of Cologne, 50924, Cologne, Germany aut NATIONALLICENCE 700 1- Seifert H. German Centre for Infection Research, partner site Bonn-Cologne, Cologne, Germany aut NATIONALLICENCE 700 1- Vehreschild M. 1st Department of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany aut NATIONALLICENCE 700 1- Glossmann J. 1st Department of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany aut NATIONALLICENCE 700 1- Franke B. 1st Department of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany aut NATIONALLICENCE 700 1- Vehreschild J. 1st Department of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany aut NATIONALLICENCE 773 0- European Journal of Clinical Microbiology & Infectious Diseases Springer Berlin Heidelberg 34/2(2015-02-01), 331-338 0934-9723 34:2<331 2015 34 10096