title: Economic outcomes of inappropriate initial antibiotic treatment for complicated skin and soft tissue infections: a multicenter prospective observational study.
abstract: This study examined economic outcomes associated with inappropriate initial antibiotic treatment (IIAT) in complicated skin and soft tissue infections using data from adults hospitalized and treated with intravenous antibiotic therapy. We specifically analyzed for the subsets of patients infected with methicillin-resistant Staphylococcus aureus (MRSA), with healthcare-associated (HCA) infections, or both. Data from 494 patients (HCA: 360; MRSA:175; MRSA + HCA: 129) showed the overall mean length of stay (LOS) was 7.4 days and 15.0% had the composite economic outcome of any subsequent hospital admissions, emergency department visits, or unscheduled visits related to the study infection. A total of 23.1% of patients had IIAT; after adjustments, these patients had longer LOS than patients without IIAT in the HCA cohort (marginal LOS = 1.39 days, P = 0.03) and the MRSA + HCA cohort (marginal LOS = 2.43 days, P = 0.01) and were significantly more likely to have the composite economic outcome in all study cohorts (odds ratio: overall = 1.79; HCA = 3.09; MRSA = 3.66; MRSA + HCA = 6.92; all P < 0.05).
authors.affiliation: University of Oxford, Oxford, UK. Electronic address: balipsky@uw.edu.
authors.forename: B A
authors.initials: BA
authors.lastname: Lipsky
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Napolitano
authors.affiliation: UCLA Medical Center, Sylmar, CA, USA.
authors.forename: G J
authors.initials: GJ
authors.lastname: Moran
authors.affiliation: Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
authors.forename: L
authors.initials: L
authors.lastname: Vo
authors.affiliation: Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
authors.forename: S
authors.initials: S
authors.lastname: Nicholson
authors.affiliation: United BioSource Corporation, Lexington, MA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Chen
authors.affiliation: United BioSource Corporation, Lexington, MA, USA.
authors.forename: L
authors.initials: L
authors.lastname: Boulanger
authors.affiliation: Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
authors.forename: M
authors.initials: M
authors.lastname: Kim
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy / Q000191:economics; D004632:Emergency Medical Services; D005260:Female; D017048:Health Care Costs; D006801:Humans; D057970:Inappropriate Prescribing / Q000191:economics*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017192:Skin Diseases, Bacterial / Q000188:drug therapy* / Q000191:economics; D018461:Soft Tissue Infections / Q000188:drug therapy* / Q000191:economics; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000191:economics; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Complicated skin and soft tissue infections; Economic outcomes; Inappropriate antibiotics treatment