title: Cost of care for inpatients with community-acquired intra-abdominal infections.
abstract: Few studies have assessed the actual costs associated with failure of initial empiric antibiotic therapy administered to patients with community-acquired intra-abdominal infections. The goals of this study were (i) to determine the frequency of unsuccessful initial empiric therapy in a real-world setting and (ii) to determine the associated impact on medical costs. Thus, a retrospective chart review was performed at four acute-care university hospitals in France. A total of 292 patients hospitalized for community-acquired intra-abdominal infection were included. The mean age of the cohort was 51 years, and 42% of the patients were female. The most commonly administered empiric regimens were intravenous amoxicillin/clavulanate alone (69 patients) or in combination with other antibiotics ( n=87) and piperacillin/tazobactam alone ( n=24) or in combination ( n=48). Other regimens included broad-spectrum penicillin, cephalosporins, and fluoroquinolones administered alone or in combination ( n=64). Empiric therapy was successful in 189 (65%) patients and unsuccessful in 103 (35%). Among the 292 patients with community-acquired infection, 15 died of the infection, 8 required reoperation and 80 required second-line antibiotic therapy. Patients with unsuccessful initial empiric therapy had significantly more parenteral antibiotic days (10.3 vs. 7.6 days) and a longer length of stay (16.2 vs. 12.8 days) compared to those with successful initial empiric therapy. A better selection of initial empiric antibiotic therapy may significantly influence the medical costs associated with patients who are hospitalized with community-acquired intra-abdominal infections.
authors.affiliation: Department of Digestive Surgery, Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75010 Paris, France. pierre.cattan@sls.ap-hop-paris.fr
authors.forename: P
authors.initials: P
authors.lastname: Cattan
authors.forename: D D
authors.initials: DD
authors.lastname: Yin
authors.forename: E
authors.initials: E
authors.lastname: Sarfati
authors.forename: R
authors.initials: R
authors.lastname: Lyu
authors.forename: M
authors.initials: M
authors.lastname: De Zelicourt
authors.forename: F
authors.initials: F
authors.lastname: Fagnani
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics; D001424:Bacterial Infections / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D003131:Combined Modality Therapy; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D016001:Confidence Intervals; D005260:Female; D005602:France; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D017721:Hospital Costs; D006785:Hospitals, University / Q000191:economics*; D006801:Humans; D007813:Laparotomy / Q000191:economics / Q000379:methods; D007902:Length of Stay / Q000191:economics; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011336:Probability; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents