Nicole Gidaya Bonine1, Ariel Berger2, Arman Altincatal2, Rosa Wang2, Tarun Bhagnani2, Patrick Gillard3, Thomas Lodise4. 1. Global Health Outcomes Strategy & Research, Allergan plc, Irvine, California. Electronic address: nicole.bonine@allergan.com. 2. Real-World Evidence, Evidera, Waltham, Massachusetts. 3. Global Health Outcomes Strategy & Research, Allergan plc, Irvine, California. 4. Albany College of Pharmacy and Health Sciences, Albany, New York.
Abstract
BACKGROUND: To examine the clinical and economic burdens associated with delayed receipt of appropriate therapy among patients with Gram-negative bacteria (GNB) infections, stratified by antibiotic resistance status. MATERIALS AND METHODS: Retrospective analysis using the Premier Hospital Database. Adult admissions (July 2011-September 2014) with evidence of complicated urinary tract infection, complicated intra-abdominal infection, hospital-associated pneumonia, or bloodstream infection, length of stay (LOS) ≥1 days and a positive GNB culture from a site consistent with infection type (culture draw date = index date) were identified and stratified by antibiotic susceptibility to index pathogens. Delayed appropriate therapy was defined as no receipt of antibiotic(s) with relevant microbiological activity on or within 2 days of index date. Inverse probability weighting and multivariate regression analyses were used to estimate the association between delayed appropriate therapy and outcomes. Generalized linear models were used to evaluate postindex duration of antibiotic therapy, LOS and total in-hospital costs. Logistic models were used to evaluate discharge destination and in-hospital mortality/discharge to hospice. RESULTS: A total of 56,357 patients with GNB infections were identified (resistant, n = 6,055; susceptible, n = 50,302). Delayed appropriate therapy was received by 2,800 (46.2%) patients with resistant and 16,585 (33.0%) patients with susceptible infections. Using multivariate analysis, delayed appropriate therapy was associated with worse outcomes including ∼70% increase in LOS, ∼65% increase in total in-hospital costs and ∼20% increase in the risk of in-hospital mortality/discharge to hospice, regardless of susceptibility status. CONCLUSIONS: Our results suggest that outcomes in patients with GNB infections, regardless of resistance status, significantly improve if timely appropriate therapy can be provided.
BACKGROUND: To examine the clinical and economic burdens associated with delayed receipt of appropriate therapy among patients with Gram-negative bacteria (GNB) infections, stratified by antibiotic resistance status. MATERIALS AND METHODS: Retrospective analysis using the Premier Hospital Database. Adult admissions (July 2011-September 2014) with evidence of complicated urinary tract infection, complicated intra-abdominal infection, hospital-associated pneumonia, or bloodstream infection, length of stay (LOS) ≥1 days and a positive GNB culture from a site consistent with infection type (culture draw date = index date) were identified and stratified by antibiotic susceptibility to index pathogens. Delayed appropriate therapy was defined as no receipt of antibiotic(s) with relevant microbiological activity on or within 2 days of index date. Inverse probability weighting and multivariate regression analyses were used to estimate the association between delayed appropriate therapy and outcomes. Generalized linear models were used to evaluate postindex duration of antibiotic therapy, LOS and total in-hospital costs. Logistic models were used to evaluate discharge destination and in-hospital mortality/discharge to hospice. RESULTS: A total of 56,357 patients with GNB infections were identified (resistant, n = 6,055; susceptible, n = 50,302). Delayed appropriate therapy was received by 2,800 (46.2%) patients with resistant and 16,585 (33.0%) patients with susceptible infections. Using multivariate analysis, delayed appropriate therapy was associated with worse outcomes including ∼70% increase in LOS, ∼65% increase in total in-hospital costs and ∼20% increase in the risk of in-hospital mortality/discharge to hospice, regardless of susceptibility status. CONCLUSIONS: Our results suggest that outcomes in patients with GNB infections, regardless of resistance status, significantly improve if timely appropriate therapy can be provided.
Authors: Sarah C J Jorgensen; Trang D Trinh; Evan J Zasowski; Abdalhamid M Lagnf; Samuel P Simon; Sahil Bhatia; Sarah M Melvin; Molly E Steed; Natalie A Finch; Taylor Morrisette; Sandy J Estrada; Joshua R Rosenberg; Susan L Davis; Michael J Rybak Journal: Antimicrob Agents Chemother Date: 2020-03-24 Impact factor: 5.191
Authors: Raymond T Suhandynata; Kyle Lund; Andrés M Caraballo-Rodríguez; Sharon L Reed; Pieter C Dorrestein; Robert L Fitzgerald; Nicholas J Bevins Journal: Lab Med Date: 2022-03-07
Authors: Kenneth P Klinker; Levita K Hidayat; Eric Wenzler; Joan-Miquel Balada-Llasat; Mary Motyl; C Andrew DeRyke; Karri A Bauer Journal: Antibiotics (Basel) Date: 2022-05-14
Authors: Laura Puzniak; Karri A Bauer; Kalvin C Yu; Pamela Moise; Lyn Finelli; Gang Ye; Carisa De Anda; Latha Vankeepuram; Vikas Gupta Journal: Open Forum Infect Dis Date: 2021-05-26 Impact factor: 3.835