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Open Access Highly Accessed Research article

Aspergillosis in Intensive Care Unit (ICU) patients: epidemiology and economic outcomes

John W Baddley1*, Jennifer M Stephens2, Xiang Ji2, Xin Gao2, Haran T Schlamm3 and Miriam Tarallo4

Author affiliations

1 Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, 1900 University Boulevard, 229 Tinsley Harrison Tower, Birmingham, AL, 35294-0006, USA

2 Pharmerit North America LLC, Bethesda, MD, USA

3 Pfizer Inc, New York, NY, USA

4 Pfizer Inc, Rome, Italy

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Citation and License

BMC Infectious Diseases 2013, 13:29  doi:10.1186/1471-2334-13-29

Published: 23 January 2013

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.

Keywords:
Aspergillosis; Voriconazole; Fluconazole; ICU; Length of stay; Hospital costs