How complicated skin and soft tissue infections are treated in Italy: economic evaluation of inpatient intravenous antibiotic treatment in seven hospitals

Tarricone, Rosanna; Aguzzi, Giovanni; Capone, Alessandro; Caravaggi, C.; Esposito, Silvano; Franzetti, Fabio; Muzzi, A; Ricci, Lucia; Bassetti, Matteo

doi:10.3111/13696990802113196

Cited by 6 publications

(11 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Interestingly, the rate of inappropriate initial antibiotic therapy dropped from 43% in 2004 to 3% in 2008 in patients with MRSA cSSTI who presented to emergency departments in a multicenter study; overall rates for patients with cSSTI due to any pathogen were not reported (24). Another difference is that only 16% of patients were hospitalized in that study (24), whereas all were hospitalized in our study and the other studies (6,25,29). In our study, the following factors were predictive of inappropriate initial antibiotic therapy: admission without presentation to the emergency room and cSSTI caused by difficult-to-treat pathogens (i.e., MRSA, both Gram-positive and Gram-negative pathogens, or pathogens other than S. aureus or streptococci).…”

Section: Discussioncontrasting

confidence: 51%

“…These rates are slightly lower than the 22%- to-23% range in other analyses of patients hospitalized with cSSTI, including two retrospective cohort studies (6, 29) and a microcosting study (25). Interestingly, the rate of inappropriate initial antibiotic therapy dropped from 43% in 2004 to 3% in 2008 in patients with MRSA cSSTI who presented to emergency departments in a multicenter study; overall rates for patients with cSSTI due to any pathogen were not reported (24).…”

Section: Discussionmentioning

confidence: 75%

“…Edelsberg et al (6) reported that this surrogate was predictive of increased mortality (odds ratio, 2.9; 95% CI, 2.3 to 3.6), excess antibiotic days (5.7 days), excess hospital LOS (5.4 days), and excess inpatient charges ($5,285) (all P Ͻ 0.01) in multivariate analyses of 47,291 patients. Tarricone et al (25) reported that failure of initial antibiotic therapy added 7 days to hospital LOS and €2,850 to hospital cost in a microcosting study of 307 patients.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Epidemiology and Outcomes of Complicated Skin and Soft Tissue Infections in Hospitalized Patients

Zervos

Freeman

et al. 2012

J Clin Microbiol

View full text Add to dashboard Cite

Complicated skin and soft tissue infections (cSSTIs) are among the most rapidly increasing reasons for hospitalization. To describe inpatients with regard to patient characteristics, cSSTI origin, appropriateness of initial antibiotics, and outcomes, we performed a retrospective cohort study in patients hospitalized for cSSTI. To identify independent predictors of outcomes, we performed multivariate analyses. Of 1,096 eligible patients, 48.7% had health care-associated (HCA) cSSTI and 51.3% had community-acquired (CA) cSSTI. After adjustment for baseline variables, hospital length of stay (LOS) was longer for HCA than for CA cSSTI (difference, 2.1 days; 95% confidence interval [CI], 0.8 to 3.5; P < 0.05). Other covariates associated with a longer LOS were need for dialysis (regression coefficient ؎ standard error, 4.5 ؎ 1.1) and diabetic wound diagnosis (2.6 ؎ 1.0) (all P < 0.05). In the subset with culture-positive cSSTI within 24 h of admission, the most common pathogen was Staphylococcus aureus (298/449 [66.4%]), of which 74.8% (223/298) were methicillin-resistant S. aureus (MRSA). Eighty-three patients (18.5%) received inappropriate initial antibiotics. After adjustment for other variables, the following were associated with inappropriate initial therapy: direct admission to hospital (not via emergency department), cSSTI caused by MRSA or mixed pathogens, and cSSTI caused by pathogens other than S. aureus or streptococci (all P < 0.05). We did not find an association between inappropriate therapy and outcomes, except in the subset with ulcers (adjusted odds ratio, 11.8; 95% CI, 1.3 to 111.1; P ‫؍‬ 0.03). More studies are needed to examine the impact of HCA cSSTI and inappropriate initial therapy on outcomes.

show abstract

Section: Discussioncontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Epidemiology and Outcomes of Complicated Skin and Soft Tissue Infections in Hospitalized Patients

Zervos

Freeman

et al. 2012

J Clin Microbiol

View full text Add to dashboard Cite

show abstract

“…In a smaller retrospective study, the authors demonstrated a greater likelihood of hospital readmission or death within 30 days in the subset of cSSTI patients with decubitus ulcers who received inappropriate initial antibiotic therapy (adjusted OR 11.76; 95% CI 1.30–111.11; p 0.03) . Furthermore, inadequate initial antibiotic therapy can increase length of hospital stay and costs . In a retrospective Italian study, failure of initial treatment in cSSTIs was estimated to cost €7835 versus €4989 when the initial antibiotic led to clinical success without the need for further IV treatment .…”

Section: Importance Of Appropriate Initial Antibiotic Therapymentioning

confidence: 98%

“… isolated S. aureus from the majority (71.1%) of infections, followed by β ‐haemolytic streptococci (10.5%) and enterococci (9.3%) . Data from an Italian study identified the Enterobacteriaceae Proteus mirabilis in 1% of cSSTIs in a population of hospitalized patients . Although less frequent, other non‐bacterial microbes can lead to cSSTIs, particularly in travellers, and, in certain circumstances, it is important to consider fungal causes, such as invasive aspergillosis, mucormycosis and other mycoses in immunocompromised patients .…”

Section: Mrsa: An Important Pathogen In Europementioning

confidence: 99%

European perspective and update on the management of complicated skin and soft tissue infections due to methicillin-resistant Staphylococcus aureus after more than 10 years of experience with linezolid

Bassetti

Baguneid

Bouza

et al. 2014

Clinical Microbiology and Infection

View full text Add to dashboard Cite

Complicated skin and soft tissue infections (cSSTIs) are a diverse group of infections, with a range of presentations and microbiological causes. Hospitalization is common for patients with a cSSTI, which is treated by drainage of the affected area and with antibiotics. Host factors such as co-morbidities, and microbial factors, in particular drug resistance, complicate the management of these infections. Methicillin-resistant Staphylococcus aureus (MRSA) is an important cSSTI pathogen in Europe, and its involvement can be associated with poor patient outcomes. European guidelines recommend vancomycin, teicoplanin, linezolid, daptomycin, tigecycline or ceftaroline for treatment of MRSA cSSTIs. Of primary importance when treating cSSTIs is the agent's clinical efficacy against the causative pathogens, as well as its bioavailability in the skin and associated structures. Linezolid is well-suited for the treatment of MRSA cSSTIs; it achieves high penetration into skin and soft tissues with 100% oral bioavailability, and therefore enables an intravenous to oral switch and outpatient treatment. When eligible patients are offered oral therapy the associated length of hospital stay and overall costs can be reduced. Linezolid has demonstrated clinical efficacy and favourable outcomes in patients for the treatment of MRSA cSSTIs including the treatment of lower extremity infections. Furthermore, efficacy has been documented in key defined populations, such as individuals with renal impairment and the obese. The safety profile of linezolid is well-documented, making this antibacterial a viable choice for the treatment of MRSA cSSTIs.

show abstract

Budget Impact Analysis of Dalbavancin in the Treatment of Acute Bacterial Skin and Skin Structure Infections in Three European Countries

et al. 2020

View full text Add to dashboard Cite

Background and Objective: Acute bacterial skin and skin structure infections have been defined by Food and Drug Administration (FDA) in 2013 to define a subset of complicated skin and skin structure infections commonly treated with parenteral antibiotic therapy. Inpatient treatment of ABSSSIs involves a significant economic burden on the health-care system. This study aimed to evaluate the economic impact on National Health System associated with the management of non-severe ABSSSIs treated in hospitals with innovative long-acting dalbavancin compared to standard antibiotic therapy in Italy, Spain and Austria.Methods: A Budget Impact Analysis was developed to evaluate the direct costs associated with the management of ABSSSI from the national public health system perspective. The model considered the possibility to early discharge patients directly from the Emergency Department (ED), after one night in the hospital or after 2 or 3 night in the hospital. A scenario with Standard of Care was compared with dalbavancin scenario, where patients had the possibility of being early discharged. The epidemiological and cost parameters were extrapolated from national administrative databases and from a systematic literature review for each Country. The analysis was conducted in a 3-year time horizon. A one-way deterministic sensitivity analysis was conducted to examine the robustness of the results. Results:The model estimated an average annual number of patients with non-severe ABSSSI in Italy, Spain and Austria equal to 5,396, 7,884 and 1,788 respectively. A total annual expenditure of about € 9.9 million, € 13.5 million and € 3.4 million was estimated for treating the full set of ABSSSI patients in Italy, Spain and Austria respectively. Dalbavancin reduced the in-hospital length of stay in each Country. In the first year of its introduction, Dalbavancin significantly reduced the total economic burden in Italy and Spain (-€ 352,252 and -€ 233,991) while it increased the total economic burden in Austria (€ 80,769, 0.7% of the total expenditure for these patients); in the third year of its introduction, Dalbavancin reduced the total economic burden in each Country (-€ 1,1 million, -€ 810,650, -€ 70,269 respectively). Conclusions:The introduction of dalbavancin in a new patients pathway to treat non-severe aBSSSI, could generate a significant reduction of hospitalized patients and the overall patient's length of stay in hospital Key Points:-Dalbavancin reduces the in-hospital length of stay in each Country.-The introduction of dalbavancin in a new patients pathway to treat non-severe aBSSSI could reduce the total economic burden in each Country.

show abstract

How complicated skin and soft tissue infections are treated in Italy: economic evaluation of inpatient intravenous antibiotic treatment in seven hospitals

Abstract: Efforts should be made to minimise the risk of selecting wrong antibiotics and to identify the quickest antibiotic in eradicating the infection.

Cited by 6 publications

References 25 publications

Epidemiology and Outcomes of Complicated Skin and Soft Tissue Infections in Hospitalized Patients

Epidemiology and Outcomes of Complicated Skin and Soft Tissue Infections in Hospitalized Patients

European perspective and update on the management of complicated skin and soft tissue infections due to methicillin-resistant Staphylococcus aureus after more than 10 years of experience with linezolid

Budget Impact Analysis of Dalbavancin in the Treatment of Acute Bacterial Skin and Skin Structure Infections in Three European Countries

Contact Info

Product

Resources

About