Secular Trends in Utilization of Critical Care Services Among Candidemia-Associated Hospitalizations: A Population-Based Cohort Study

BACKGROUND The incidence of candidemia continues to rise in recent years. Candidemic patients often require care in an intensive care unit (ICU) and can consume substantial resources. However, there are no contemporary longitudinal population-level data on the incidence patterns of ICU utilization among patients with candidemia in the United States. METHODS The Texas Inpatient Public Use Data File was used to identify hospitalized patients aged ≥ 18 years for the years 2001 - 2010. Hospitalizations with candidemia were identified by presence of an International Classification of Diseases, Ninth Revision, Clinical Modification Code 112.5. The annual rates of ICU admission among candidemia hospitalizations were examined. The annual incidence of candidemia hospitalizations with admission to ICU (C-ICU) was evaluated using the United States Census data, and was also benchmarked against the number of all hospitalizations and hospitalizations with ICU admission, overall and for age-specific strata. RESULTS There were 11,544 hospitalizations with candidemia, including 7,552 (65.4%) with C-ICU. Between 2001 and 2010, the rate of C-ICU among hospitalizations with candidemia increased from 60.2% to 68.0%, and the incidence of C-ICU increased by 91%, rising from 2.73 to 5.21 per 100,000 population. When benchmarked against hospital admissions and ICU admissions, the following changes were noted between 2001 and 2010 in the incidence of C-ICU: 1.61 vs. 3.34 per 10,000 hospitalizations, and 8.33 vs. 13.77 per 10,000 hospitalizations with ICU admission. The incidence of C-ICU rose rapidly during the first half of the last decade, while plateauing during the remainder of study period. There has been marked difference in the rate of rise in the incidence of C-ICU among examined age strata, being highest among the 18 - 44 year group. CONCLUSIONS ICU care occurred in the majority of candidemia hospitalizations. The incidence of C-ICU rose nearly two-fold during study period, but the rise plateaued during the second half of the last decade. Substantial heterogeneity was noted in the rate of rise in the incidence of C-ICU across examined age groups. Further study in other populations is required to corroborate our findings and examine the sources of the observed trends.