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Published Online, 2 October 2007, www.theannals.com, DOI 10.1345/aph.1H516b.
 The Annals of Pharmacotherapy: Vol. 41, No. 11, pp. 1917. DOI 10.1345/aph.1H516b
© 2007 Harvey Whitney Books Company.
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Authors' Reply

Susan L Davis, PharmD

Clinical Assistant Professor of Pharmacy Practice, Wayne State University, Clinical Specialist, Henry Ford Hospital, Detroit, Michigan

Peggy S McKinnon, PharmD

Clinical Pharmacist in Clinical Research and Infectious Diseases, Department of Pharmacy/Clinical Research/Infections, Barnes-Jewish Hospital, 216 South Kingshighway, MS 90-52-411, St. Louis, Missouri 63110, fax 314/747-2185, psm9154{at}bjc.org

Published Online, October 2, 2007. www.theannals.com, DOI 10.1345/aph.1H516b

We thank Vandijck et al. for pointing out difficulties in interpretation of cost and epidemiology of candidemia. With respect to economic analysis, our intention in assessing the cost of only survivors was to avoid artificial reduction of cost in patients who die soon after the onset of infection, which could overestimate costs in patients who survive. In post hoc analysis of our own data, the cost in patients who died was, in fact, lower than that in patients who survived. Ideally, comprehensive cost-effectiveness analysis could be performed to take into consideration these and other confounding factors. However, such an assessment was beyond the scope of our study.

Concerns were raised with respect to the power to detect an association between fluconazole exposure and non-albicans vs C. albicans candidemia. As we discussed, the population studied had very low incidence of prior antifungal use. The low rate of fluconazole use would make it very impractical to study this association as a primary endpoint at this particular institution. While a patient population of this nature is certainly not universal, it is also not entirely unique, and we feel that a better understanding of risk factors in this situation can be valuable.

Finally, we appreciate the interest of Vandijck et al., as the concerns they raise are important considerations in the design of future research of Candida infections.

Footnotes

Dr. McKinnon is on the Consultancy/Speaker's Board of Pfizer, Schering-Plough, and Astellas.





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