Torres W, Ramirez-Ronda CH, Gonzalez G, Martinez GA; Interscience Conference on Antimicrobial Agents and Chemotherapy.

Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 1998 Sep 24-27; 38: 479 (abstract no. J-98).

San Juan VAMC, Puerto Rico.

Purpose: To determine the cost effectiveness of 3 treatment regimes, oral fluconazole (OF), amphotericin B (AMB) single dose (AMBSD) or amphotericin B irrigation (AMBI) in the management of candiduria. Methods: Patients with documented candiduria were randomized to receive OF 200 mg first day followed by 100 mg daily for 2 days, AMB 0.3 mg/kg IV over 6 hours as a single dose or AMB 10mg/L by continuous irrigation for 3 days. Urinalysis and cultures were repeated at end of therapy at 2 and 6 weeks post therapy. Results: A total of 365 patients with candiduria were screened on repeat catherized urine 135 persisted with candiduria and was selected for the study. They were randomized to OF, AMBSD or AMBI. A total of 100 patients completed therapy. Microbiologic eradication was found in 38/38 on OF, 27/30 on AMBSD and 26/32 on AMBI. Eradication rates immediately post therapy at 2 and 6 weeks were comparable. The medication cost per treatment was $15.13 for OF, $22.03 for AMBSD and $24.04 for AMBI. In order to documented candiduria with a repeat catherized urine you must screen 3-4 patients at a cost of $40.00 each, for a pre-treatment intervention expense of $120.00-$160.00 per treated patient. If you treat only documented bacteriuria the expense/pt would be $135.13-$175.13, if on the contrary you treat with OF all candidurias and do not repeat the catherized urinalysis, the cost for treating four patients is $60.52. This approach represents a net saving per patient of $40.00. At our institution with over 1200 urinalysis with candiduria, the use of empiric OF in this population results in a saving of $48,000.00 per year. There was no evidence of the emergence of resistance to fluconazole. Conclusions: We are frequently faced with the dilemma of deciding whether a patient's candiduria is a colonizer or an infectious agent. Repeated catherized urinalysis helps select those with true candiduria but this is expensive. The use of OF in 3 doses was found to be universally effective and there was no evidence of emergence of resistance.

Publication Types:

• Meeting Abstracts

Keywords:

• Amphotericin B
• Bacteriuria
• Candidiasis
• Cost-Benefit Analysis
• Costs and Cost Analysis
• Fluconazole
• Humans
• Irrigation
• Urinalysis
• Urinary Tract Infections
• economics

Other ID:

• 20711137

UI: 102188498

From Meeting Abstracts