title: Antibiotic treatment patterns across Europe in patients with complicated skin and soft-tissue infections due to meticillin-resistant Staphylococcus aureus: a plea for implementation of early switch and early discharge criteria.
abstract: This retrospective observational medical chart review aimed to describe country-specific variations across Europe in real-world meticillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft-tissue infection (cSSTI) treatment patterns, antibiotic stewardship activity, and potential opportunities for early switch (ES) from intravenous (i.v.) to oral formulations and early discharge (ED) from hospital using standardised data collection and criteria and economic implications of these opportunities. Patients were randomly sampled from 12 countries (Austria, Czech Republic, France, Germany, Greece, Ireland, Italy, Poland, Portugal, Slovakia, Spain and the UK), aged ≥18 years, with documented MRSA cSSTI, hospitalised between 1 July 2010 and 30 June 2011, discharged alive by 31 July 2011. Of 1502 patients, 1468 received MRSA-targeted therapy. Intravenous-to-oral switch rates ranged from 2.0% to 20.2%, i.v. length of therapy from 10.1 to 18.6 days and hospital length of stay (LoS) from 15.2 to 25.0 days across Europe. Of 341 sites, 82.9% had antibiotic steering committees, 23.7% had i.v.-to-oral switch antibiotic protocols and 12.9% had ED protocols for MRSA cSSTI. ES and ED eligibility ranged from 12.0% (Slovakia) to 56.3% (Greece) and from 10% (Slovakia) to 48.2% (Portugal), respectively. Potential cost savings per ED-eligible patient ranged from €414 (Slovakia) to €2703 (France). MRSA cSSTI treatment patterns varied widely across countries, but further reductions in i.v. therapy, hospital LoS and associated costs could be realised. These data provide insight into clinical practice patterns across diverse European healthcare systems and identify potential opportunities for local clinicians and policy-makers to improve clinical care and cost-effectiveness of this therapeutic area.
authors.affiliation: Klinikum Peine and Medical University Hannover, Peine, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Eckmann
authors.affiliation: Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Wendy
authors.initials: W
authors.lastname: Lawson
authors.affiliation: Ninewells Hospital & Medical School, Dundee, UK.
authors.forename: Dilip
authors.initials: D
authors.lastname: Nathwani
authors.affiliation: Pharmerit International, Bethesda, MD, USA.
authors.forename: Caitlyn T
authors.initials: CT
authors.lastname: Solem
authors.affiliation: Pharmerit International, Bethesda, MD, USA. Electronic address: jstephens@pharmerit.com.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Stephens
authors.affiliation: Medical Data Analytics, Parsippany, NJ, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Macahilig
authors.affiliation: Pfizer IO, Paris, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Simoneau
authors.affiliation: Pfizer Inc., Prague, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Hajek
authors.affiliation: Pfizer IO, Paris, France.
authors.forename: Claudie
authors.initials: C
authors.lastname: Charbonneau
authors.affiliation: Pfizer Inc., Collegeville, PA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Chambers
authors.affiliation: Pfizer Inc., La Jolla, CA, USA.
authors.forename: Jim Z
authors.initials: JZ
authors.lastname: Li
authors.affiliation: Pfizer Inc., Groton, CT, USA.
authors.forename: Seema
authors.initials: S
authors.lastname: Haider
mesh_terms: D000081:Acetamides / Q000191:economics / Q000627:therapeutic use*; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005060:Europe; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007275:Injections, Intravenous; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D000069349:Linezolid; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000254:growth & development; D008875:Middle Aged; D023303:Oxazolidinones / Q000191:economics / Q000627:therapeutic use*; D010351:Patient Discharge; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology / Q000473:pathology; D013207:Staphylococcal Skin Infections / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology / Q000473:pathology; D014640:Vancomycin / Q000191:economics / Q000627:therapeutic use*
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid
keywords: Economics; Intravenous line days; Intravenous-to-oral antibiotic switch; Length of stay; Linezolid; Vancomycin