P-968. Strategies to Optimize Candidemia Management at Hospital Discharge

TL;DR

This study evaluates strategies to optimize the management of candidemia at hospital discharge, aiming to reduce hospital stays and healthcare costs.

Contribution

The study introduces a transition criteria for switching to oral or long-acting antifungal treatments to facilitate discharge.

Findings

36% of patients met the transition criteria for long-acting injectable echinocandin.

Using the transition criteria could reduce hospital length of stay by 5.4 to 5.9 days.

Healthcare costs could decrease by $13,192 to $14,307 per patient using the transition criteria.

Abstract

Candidemia or invasive candidiasis (C/IC) are associated with high rates of morbidity and mortality. An empiric echinocandin is recommended by the treatment guidelines. However, the optimal time to de-escalate or transition to outpatient management has not been clearly defined due to limited data, especially among neutropenic patients, and delayed susceptibility results from send-out practice. We aimed to evaluate the utility of a C/IC transition criteria and the impact on hospital discharge and associated healthcare cost.

A single center, retrospective observational study was conducted on hospitalized adult patients with documented Candida species growing from a sterile site culture who received an echinocandin regardless of neutropenia or intensive care unit (ICU) admission between January 1st, 2019 to December 31st, 2024. Patients with endocarditis, osteomyelitis, or meningitis were excluded. A C/IC transition criteria was developed to assess the appropriate time to transition to oral fluconazole (OF) or long acting injectable echinocandin (LAI-E) rezafungin to initiate discharge planning. The primary endpoint was the proportion of patients eligible for discharge with either OF or LAI-E. Secondary endpoints were differences in hospital length of stay (LOS) and associated cost based on transition criteria eligibility.

Of 107 study patients, the mean age was 63 years, 60% were male, 11% were in the ICU and 3% were neutropenic. The common comorbidities included diabetes (27%), congestive heart failure (12%) and chronic kidney disease (12%). Twenty-three patients died before eligibility could be assessed. In total, 36% met the transition criteria for LAI-E, among whom 25% were also eligible for OF. Younger age, Hispanic ethnicity, private insurance, or Medicare insurance were predictors for LAI-E qualification. Using the transition criteria for OF and LAI-E respectively, LOS would decrease by 5.4 days and 5.9 days and healthcare costs would decrease by $13,192 and $14,307 per patient.

Optimization of I/IC treatment using a customized transition criteria and innovative outpatient method is an effective antifungal stewardship tool with potential to decrease LOS and healthcare costs.

All Authors: No reported disclosures