Tuesday, 5 February 2013

Which Patient Groups Are Most at Risk From Aspergillosis in Hospital

This study collected a large amount of data on invasive aspergillosis patients in  intensive care units (ICU) at a group of  North American hospitals in order to assess the major groups at risk of invasive aspergillosis (other than those groups already well established as high risk) and the financial cost to those hospitals of treating those patients, with regard to how costs could be reduced.

It is worth noting that these patients are seriously ill and are in hospital as a consequence of that illness. These are not people with chronic pulmonary aspergillosis (CPA) or aspergilloma, ABPA or any other chronic form of aspergillosis, they have an acute infection that rapidly progresses, normally due to the patient having a suppressed immune system. Acute invasive aspergillosis is rare outside of the hospital setting.
Abstract 
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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