Association Between Duration of Candidemia and Clinical and Healthcare Resource Utilization Outcomes Among Hospitalized Adult Patients With Candidemia Who Received Empiric Treatment With an Echinocandin Across United States Hospitals.

Abstract

Time to bloodstream clearance is a critical prognostic indicator in various infections, yet limited data exist on the relationship between time to mycological clearance and outcomes in candidemia. This study aimed to assess the association between the duration of candidemia and outcomes in adult, hospitalized patients receiving empiric echinocandin treatment across US hospitals. A retrospective, multicenter study using the PINCI AI Healthcare Database (1/2016-4/2019) was conducted. Inclusion criteria: hospitalized adults (≥18 years) with Candida spp. identified on a clinical blood culture who received empiric echinocandin therapy (±2 days of index Candida spp. blood culture) for ≥3 days. Outcomes assessed were in-hospital mortality, length of stay, and hospital costs. The associations between increasing duration of candidemia relative to a single day of candidemia and outcomes were examined. A total of 867 patients met the criteria. Multivariable analysis showed that patients with candidemia lasting more than 1 day had significantly higher mortality, longer length of stay, and higher hospital costs compared to those with only 1 day of candidemia. For each additional day of candidemia, the adjusted odds of in-hospital mortality increased by 3%, the adjusted median hospital length of stay after index collection day increased by 1.0 days, and the adjusted median total costs after index collection day increased by $3006. Prolonged candidemia is associated with worse patient outcomes and higher healthcare costs. Further large-scale studies are needed to confirm these findings given the exploratory and observational nature of this study.