title: Variations in antimicrobial use and cost in more than 2,000 patients with community-acquired pneumonia.
abstract: OBJECTIVE
  To assess the patterns of antimicrobial use, costs of antimicrobial therapy, and medical outcomes by institution in patients with community-acquired pneumonia.
  
  
  METHODS
  The route, dose, and frequency of administration of all antimicrobial agents prescribed within 30 days of presentation were recorded for 927 outpatients and 1328 inpatients enrolled in the Pneumonia Patient Outcomes Research Team (PORT) multicenter, prospective cohort study. Total antimicrobial costs were estimated by summing drug costs, using average wholesale price for oral agents and institutional acquisition prices for parenteral agents, plus the costs associated with preparation and administration of parenteral therapy. Thirty-day outcome measures were mortality, subsequent hospitalization for outpatients, and hospital readmission for inpatients.
  
  
  RESULTS
  Significant variation (P <0.05) in prescribing practices occurred for 17 of the 23 antimicrobial agents used in outpatients across 5 treatment sites, and for 18 of the 20 parenteral agents used in inpatients across 4 treatment sites. The median duration of antimicrobial therapy for treatment site ranged from 11 to 13 days for outpatients (P=0.01), and from 13 to 15 days for inpatients (P=0.49). The overall median cost of antimicrobial therapy was $12.90 for outpatients, and ranged from $10.80 to $58.90 among treatment sites (P <0.0001). The overall median cost of antimicrobial therapy was $228.70 for inpatients, and ranged from $183.70 to $315.60 among sites (P <0.0001). Mortality and hospital readmission for inpatients were not significantly different across sites after adjusting for baseline differences in patient demographic characteristics, comorbidity, and illness severity. Although subsequent hospitalization for outpatients differed by site, the rate was lowest for the site with the lowest antimicrobial costs.
  
  
  CONCLUSIONS
  Variations in antimicrobial prescribing practices by treatment site exist for outpatients and inpatients with community-acquired pneumonia. Although variation in antimicrobial prescribing practices across institutions results in significant differences in antimicrobial costs, patients treated at institutions with the lowest antimicrobial costs do not demonstrate worse medical outcomes.
authors.affiliation: Department of Medicine, St. Joseph's Health Center and Faculty of Medicine, University of Western Ontario, London, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Gilbert
authors.forename: P P
authors.initials: PP
authors.lastname: Gleason
authors.forename: D E
authors.initials: DE
authors.lastname: Singer
authors.forename: T J
authors.initials: TJ
authors.lastname: Marrie
authors.forename: C M
authors.initials: CM
authors.lastname: Coley
authors.forename: D S
authors.initials: DS
authors.lastname: Obrosky
authors.forename: J R
authors.initials: JR
authors.lastname: Lave
authors.forename: W N
authors.initials: WN
authors.lastname: Kapoor
authors.forename: M J
authors.initials: MJ
authors.lastname: Fine
mesh_terms: D000890:Anti-Infective Agents / Q000191:economics* / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000191:economics* / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010359:Patient Readmission; D011014:Pneumonia / Q000188:drug therapy* / Q000191:economics* / Q000382:microbiology; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents