title: Treatment failure in pneumonia: impact of antibiotic treatment and cost analysis.
abstract: The aim of this study was to investigate treatment failure (TF) in hospitalised community-acquired pneumonia (CAP) patients with regard to initial antibiotic treatment and economic impact. CAP patients were included in two open, prospective multicentre studies assessing the direct costs for in-patient treatment. Patients received treatment either with moxifloxacin (MFX) or a nonstandardised antibiotic therapy. Any change in antibiotic therapy after >72 h of treatment to a broadened antibiotic spectrum was considered as TF. Overall, 1,236 patients (mean ± SD age 69.6 ± 16.8 yrs, 691 (55.9%) male) were included. TF occurred in 197 (15.9%) subjects and led to longer hospital stay (15.4 ± 7.3 days versus 9.8 ± 4.2 days; p < 0.001) and increased median treatment costs (€2,206 versus €1,284; p<0.001). 596 (48.2%) patients received MFX and witnessed less TF (10.9% versus 20.6%; p < 0.001). After controlling for confounders in multivariate analysis, adjusted risk of TF was clearly reduced in MFX as compared with β-lactam monotherapy (adjusted OR for MFX 0.43, 95% CI 0.27-0.68) and was more comparable with a β-lactam plus macrolide combination (BLM) (OR 0.68, 95% CI 0.38-1.21). In hospitalised CAP, TF is frequent and leads to prolonged hospital stay and increased treatment costs. Initial treatment with MFX or BLM is a possible strategy to prevent TF, and may thus reduce treatment costs.
authors.affiliation: Dept of Respiratory Medicine, University Hospital Berne, Inselspital and University of Berne, 3010 Berne, Switzerland. sebastian.ott@insel.ch
authors.forename: S R
authors.initials: SR
authors.lastname: Ott
authors.forename: B M
authors.initials: BM
authors.lastname: Hauptmeier
authors.forename: C
authors.initials: C
authors.lastname: Ernen
authors.forename: P M
authors.initials: PM
authors.lastname: Lepper
authors.forename: E
authors.initials: E
authors.lastname: Nüesch
authors.forename: M W
authors.initials: MW
authors.lastname: Pletz
authors.forename: J
authors.initials: J
authors.lastname: Hecht
authors.forename: T
authors.initials: T
authors.lastname: Welte
authors.forename: T T
authors.initials: TT
authors.lastname: Bauer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001372:Aza Compounds / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000191:economics; D004359:Drug Therapy, Combination / Q000191:economics; D005260:Female; D024841:Fluoroquinolones; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D018942:Macrolides / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D000077266:Moxifloxacin; D011014:Pneumonia / Q000188:drug therapy* / Q000191:economics; D011804:Quinolines / Q000627:therapeutic use*; D017211:Treatment Failure; D047090:beta-Lactams / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D018942:Macrolides; D011804:Quinolines; D047090:beta-Lactams; D000077266:Moxifloxacin