Children's Hospital of Philadelphia

Value, 2009

October 2008

AHRQ's Nationwide Inpatient Sample (NIS) and Kids' Inpatient Database (KID), from the Healthcare Cost and Utilization Project (HCUP), have been used to influence changes in preventing invasive, hospital-acquired candidiasis in infants. Candidiasis, commonly known as a yeast infection or thrush, is considered a fungal infection.

Theoklis Zaoutis, MD, MSCE, Assistant Professor of Pediatrics and Epidemiology, Director, Pediatric Infectious Diseases Fellowship, and Associate Director, Center for Pediatric Clinical Effectiveness, at the Children's Hospital of Philadelphia, led the research. Zaoutis discovered HCUP databases while searching for good pediatric data related to the emergence of resistant organisms.

The incidence of candidiasis was increasing in neonatal intensive care units (NICUs), Zaoutis had observed. Many extra-low-birthweight infants were succumbing to invasive candidiasis; Zaoutis wanted to help define which outcomes were directly attributable to invasive neonatal candidiasis.

Zaoutis and his colleagues used the HCUP databases to investigate the rate, mortality, lengths of stay, and associated costs of neonatal hospitalizations. The NIS and KID allowed the researchers to analyze illnesses and conditions that affect both children and adults.

Zaoutis' research helped define just how serious this infection is in NICUs. The researchers found that 10 percent of mortality can be directly attributed to invasive candidiasis. Patients designated as extra-low-birthweight who had candidiasis were twice as likely to die than patients of similar weight without the diagnoses. Though the condition did not create a longer length of stay, the costs attributable to extra-low-birthweight patients were over $39,000 more than those with a normal birth weight.

The research findings have the potential for substantial improvements in the practice of treating extra-low-birthweight infants and for prevention of invasive, hospital-acquired candidiasis.

Impact Case Study Identifier: CDOM 09-01
AHRQ Product(s): Healthcare Cost & Utilization Project—Nationwide Inpatient Sample, Kids' Inpatient Database (HCUP-NIS, KID)
Topic(s): Pediatrics
Scope: Pennsylvania

Zaoutis TE, et al. Risk factors for and outcomes of bloodstream infection caused by extended spectrum beta-lactamase producing Escherichia coli and Klebsiella species in children. Pediatrics 2005; 115: 942-949.