Treatment failure in pneumonia: impact of antibiotic treatment and cost analysis

Ott, Sebastian Robert; Hauptmeier, B.; Ernen, C; Lepper, Philipp M.; Nüesch, Eveline; Pletz, Mathias W.; Hecht, Jonathan; Welte, Tobias; Bauer, Torsten T.

doi:10.1183/09031936.00098411

Cited by 48 publications

(57 citation statements)

References 34 publications

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“…These expenditures are higher compared to similar studies performed in Germany and Spain (median costs of €1,362 [23], €1,683 [24] and €1,553 [25], respectively), but lower than reported in a study from the United Kingdom (£1,700-5,100, depending on length of stay [7]) and a European study (US$6,530 in a secondary-level hospital in the Netherlands and US$8,444 in a teaching hospital) [26]. The most likely explanation for these discrepancies in hospital costs are expected to be differences in registration, and individual resource item prices.…”

Section: Discussioncontrasting

confidence: 55%

Microbial aetiology, outcomes, and costs of hospitalisation for community-acquired pneumonia; an observational analysis

et al. 2014

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BackgroundThe aim of this study was to investigate the clinical outcome and especially costs of hospitalisation for community-acquired pneumonia (CAP) in relation to microbial aetiology. This knowledge is indispensable to estimate cost-effectiveness of new strategies aiming to prevent and/or improve clinical outcome of CAP.MethodsWe performed our observational analysis in a cohort of 505 patients hospitalised with confirmed CAP between 2004 and 2010. Hospital administrative databases were extracted for all resource utilisation on a patient level. Resource items were grouped in seven categories: general ward nursing, nursing on ICU, clinical chemistry laboratory tests, microbiology exams, radiology exams, medication drugs, and other.linear regression analyses were conducted to identify variables predicting costs of hospitalisation for CAP.ResultsStreptococcus pneumoniae was the most identified causative pathogen (25%), followed by Coxiella burnetii (6%) and Haemophilus influenzae (5%). Overall median length of hospital stay was 8.5 days, in-hospital mortality rate was 4.8%.Total median hospital costs per patient were €3,899 (IQR 2,911-5,684). General ward nursing costs represented the largest share (57%), followed by nursing on the intensive care unit (16%) and diagnostic microbiological tests (9%). In multivariate regression analysis, class IV-V Pneumonia Severity Index (indicative for severe disease), Staphylococcus aureus, or Streptococcus pneumonia as causative pathogen, were independent cost driving factors. Coxiella burnetii was a cost-limiting factor.ConclusionsMedian costs of hospitalisation for CAP are almost €4,000 per patient. Nursing costs are the main cause of these costs.. Apart from prevention, low-cost interventions aimed at reducing length of hospital stay therefore will most likely be cost-effective.

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Section: Discussioncontrasting

confidence: 55%

Microbial aetiology, outcomes, and costs of hospitalisation for community-acquired pneumonia; an observational analysis

et al. 2014

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“…The observation that more early responders had been treated with amoxicillin–clavulanate monotherapy than later responders may be an indication that this treatment is recommended in local hospital guidelines for the treatment of CAP. In a recent study of treatment failure in patients hospitalized with CAP in Switzerland, it was found that those patients who had been treated initially with moxifloxacin or a β-lactam plus macrolide combination experienced lower treatment failure rates and reduced hospital stay, and thus reduced treatment costs, compared with patients receiving β-lactam monotherapy or a non-standardized antibiotic therapy [17]. …”

Section: Discussionmentioning

confidence: 99%

Early versus later response to treatment in patients with community-acquired pneumonia: analysis of the REACH study

et al. 2014

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BackgroundKey goals in the treatment of CAP include early response to treatment and achievement of clinical stability. The US FDA recommends early response endpoints (72 hours after initiation of treatment) in clinical trials for the treatment of community-acquired bacterial pneumonia. REACH (REtrospective Study to Assess the Clinical Management of Patients With Moderate-to-Severe Complicated Skin and Soft Tissue Infections [cSSTI] or CAP in the Hospital Setting) was a retrospective observational study, providing current data on the clinical management and resource burden of CAP in real-life settings in European hospitals. This analysis reviews the characteristics and outcomes of patients showing early positive response to treatment (time to clinical stability [TCS] ≤4 days, as assessed by Halm’s criteria) compared with patients with later positive response (TCS >4 days).MethodsPatients were adults, hospitalized with CAP (2010–2011) and requiring in-hospital treatment with intravenous antibiotics.ResultsOf the 2039 patients included in REACH, 585 (28.7%) had TCS assessed by Halm’s criteria: 332 (56.8%) showed early response (median 3.0 days), and 253 (43.2%) showed later response to treatment (median 7.0 days). Use of Halm’s criteria varied across participating countries, ranging from 0% (Belgium) to 49.1% (UK). Patient characteristics and relevant medical history were similar between the two groups. There were no notable differences in initial antibiotic therapy between groups, except that more early responders had been treated with amoxicillin–clavulanate and amoxicillin monotherapy (22.6%; 7.5%, respectively) than later responders (5.9%; 1.2%, respectively). Initial treatment modification and re-infection or recurrences were less frequent in early responders compared with later responders (14.2% and 3.3% vs. 34.8% and 5.9%, respectively). Early responders had a shorter duration of hospitalization (mean 9.4 ± SD 7.0; median 8.0 days vs. mean 15.6 ± SD 10.5; median 12.0 days, respectively), lower rate of ICU admission (3.3% vs. 21.3%) and shorter duration of ICU stay (mean 6.2 ± SD 5.7; median 4.0 days vs. mean 10.4 ± SD 10.1; median 8.0 days, respectively) compared with later responders. Mortality was low in both groups.ConclusionsAchieving early clinical stabilization in CAP (≤4 days) is associated with improved outcomes, lower requirement for initial treatment modification or readmission and lower resource use, compared with a later response.Trial registrationNCT01293435

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“…12 Clinical treatment failure of patients with pneumonia is associated with increases in overall health care costs, longer hospital LOS, and higher mortality rates. 28,[85][86][87] Oster et al 86 reviewed the clinical and economic consequences of treatment failure in hospitalized patients with CAP and found that failure of initial therapy in these patients was related to significantly higher case fatality rates (8.5% vs 3.3%; P , 0.01), additional days in the hospital (mean ± SD, 10.1 ± 8.1 vs 4.9 ± 3.3 days; P , 0.01), and increased additional hospital charges (mean ± SD, $37 602 ± $71 876 vs $14 371 ± $21 633; P , 0.01) compared with patients who received a successful initial treatment regimen. 86 Delayed effective treatment of patients with pneumonia caused by S. aureus is also associated with high rates of morbidity and mortality and increased hospital costs.…”

Section: Clinical Implications Of Changing Epidemiology and Impact Onmentioning

confidence: 99%

The Changing Microbiologic Epidemiology of Community-Acquired Pneumonia

Aliberti

Kaye

2013

Postgraduate Medicine

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Community-acquired pneumonia (CAP) is a common infectious disease in the United States and the incidence continues to grow as the aging population increases. Overall, in-hospital patient mortality rates have been reported to be as high as 18%. Management of patients with CAP has been challenged by the evolution of resistant pathogens (particularly Streptococcus pneumoniae and Staphylococcus aureus) that have reduced susceptibility to recommended standard antimicrobial agents. Streptococcus pneumoniae continues to be the most frequently identified pathogen in CAP and recently, S. aureus has been found to be the second most often identified pathogen. Data from the SENTRY Antimicrobial Surveillance Program has shown declining susceptibility of pneumococci to penicillin, amoxicillin/clavulanate, and ceftriaxone from 1998 through 2011. In the Assessing Worldwide Resistance Evaluation (AWARE) surveillance program, > 50% of all S. aureus isolates from patient bloodstream infections, skin and skin structure infections, and pneumonia were methicillin-resistant. Stratifying risk factors to identify patients at risk for community-acquired multidrug-resistant pathogens should be considered when selecting therapy. Differences in microbiology and outcomes have been noted in patients presenting from the community with recent exposure to the health care system (eg, nursing home residents, patients with a recent hospital admission). These patients are at an increased risk of an infection caused by a multidrug-resistant pathogen. Understanding a patient's risk for drug-resistant pathogens will allow the physician to choose an appropriate empiric treatment regimen to optimize clinical outcomes.

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Treatment failure in pneumonia: impact of antibiotic treatment and cost analysis

Cited by 48 publications

References 34 publications

Microbial aetiology, outcomes, and costs of hospitalisation for community-acquired pneumonia; an observational analysis

Microbial aetiology, outcomes, and costs of hospitalisation for community-acquired pneumonia; an observational analysis

Early versus later response to treatment in patients with community-acquired pneumonia: analysis of the REACH study

The Changing Microbiologic Epidemiology of Community-Acquired Pneumonia

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