title: Hospital resource utilization with doripenem versus imipenem in the treatment of ventilator-associated pneumonia.
abstract: BACKGROUND
  Ventilator-associated pneumonia (VAP) is a common nosocomial infection that is associated with prolonged length of stay (LOS) and significant mortality.
  
  
  OBJECTIVE
  The aim of this study was to compare resource utilization with doripenem, an investigational carbapenem, versus imipenem from a hospital perspective among patients with VAP.
  
  
  METHODS
  This analysis was based on data from a Phase III, randomized, open-label, noninferiority study that compared clinical cure of VAP with doripenem 500 mg q8h i.v. (4-hour infusion) with imipenem 500 mg q6h (30-minute infusion) or 1000 mg q8h i.v. (1-hour infusion). Total hospital LOS, intensive care unit (ICU) LOS, and time on mechanical ventilation for doripenem and imipenem were compared in a clinical modified intent-to-treat population. P values were determined using the generalized Wilcoxon test, which compared treatments in a time-to-event analysis, censoring patients at the late follow-up visit (28-35 days after the end of i.v. therapy).
  
  
  RESULTS
  Patients in the doripenem and imipenem groups had similar baseline clinical characteristics. Median hospital LOS was significantly shorter with doripenem versus imipenem (22 vs 27 days; P=0.010); median time on mechanical ventilation was significantly shorter for doripenem (7 vs 10 days; P=0.034); median ICU LOSs were similar between the 2 groups (12 vs 13 days). Clinical cure and mortality rates were similar.
  
  
  CONCLUSIONS
  Of the 3 primary end points in this analysis, hospital LOS and time on mechanical ventilation were significantly shorter with doripenem compared with imipenem; no statistical significance was observed in ICU LOS. These findings suggest that doripenem use may be associated with an economic and clinical benefit to patients and hospitals.
authors.affiliation: Johnson & Johnson Pharmaceutical Services, LLC, Raritan, New Jersey 08869-0602, USA. smercha5@psmus.jnj.com
authors.forename: Sanjay
authors.initials: S
authors.lastname: Merchant
authors.forename: Chris
authors.initials: C
authors.lastname: Gast
authors.forename: Dilip
authors.initials: D
authors.lastname: Nathwani
authors.forename: Michael
authors.initials: M
authors.lastname: Lee
authors.forename: Alvaro
authors.initials: A
authors.lastname: Quintana
authors.forename: Nzeera
authors.initials: N
authors.lastname: Ketter
authors.forename: Ian
authors.initials: I
authors.lastname: Friedland
authors.forename: Michael
authors.initials: M
authors.lastname: Ingham
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D015780:Carbapenems / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D000077726:Doripenem; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D015378:Imipenem / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D015378:Imipenem; D000077726:Doripenem