title: Cost of care and antibiotic prescribing attitudes for community-acquired complicated intra-abdominal infections in Italy: a retrospective study.
abstract: BACKGROUND
  Complicated intra-abdominal infections (cIAIs) are a common cause of morbidity worldwide, and in spite of improvements in patient care, therapeutic failure still occurs, impacting in-hospital resource consumption. This study aimed to assess the costs associated with the treatment of community-acquired cIAIs, from the Italian National Health Service perspective.
  
  
  METHODS
  This retrospective study analyzed the charts of patients who were discharged from four Italian university hospitals between January 1 and December 31, 2009 with a primary diagnosis of community-acquired cIAIs. Patient characteristics, diagnosis, surgical procedure, antibiotic therapy, and length of hospital stay were all recorded and the cost of total hospital care was estimated. Costs were calculated in Euros at 2009 values.
  
  
  RESULTS
  The records of 260 patients (mean age 48.9 years; 57% males) were analyzed. The average cost of care for a patient hospitalized due to cIAI was €4385 (95% CI 3650-5120), with an average daily cost of €419 (95% CI 378-440). Antibiotic therapy represented just under half (44.3%) of hospitalization costs. The strongest predictor of the increase in hospital costs was clinical failure: patients who clinically failed received an average of 8.2 additional days of antibiotic therapy and spent 11 more days in hospital compared with patients who responded to first-line therapy (both p < 0.05 vs. patients who were successfully treated). Furthermore, they incurred €5592 in additional hospitalization costs (2.88 times the cost associated with clinical success) with 53% (€2973) of the additional costs attributable to antibiotic therapy. Overall, antibiotic appropriateness rate was 78.8% (n = 205), and was significantly higher in patients receiving combination therapy compared with those treated with monotherapy (97.3% vs. 64.6%).
  
  
  CONCLUSIONS
  The results of this study suggest that hospitals need to be aware of the clinical and economic consequences of antibiotic therapy of cIAIs and to reduce overall resource use and costs by improving the rate of success with appropriate initial empiric therapy.
authors.affiliation: Anesthesia and Intensive Care Unit - Emergency and Organ Transplantation Department, University of Bari, Policlinico of Bari, P.zza G. Cesare 11, 70124 Bari, Italy.
authors.forename: Lidia
authors.initials: L
authors.lastname: Dalfino
authors.affiliation: Anesthesia and Intensive Care Unit - Emergency and Organ Transplantation Department, University of Bari, Policlinico of Bari, P.zza G. Cesare 11, 70124 Bari, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bruno
authors.affiliation: Department of General Surgery, Fatebenefratelli-Isola Tiberina, Rome, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Colizza
authors.affiliation: Clinical Infectious Disease, Department of Pathology, University of Verona, Verona, Italy.
authors.forename: Ercole
authors.initials: E
authors.lastname: Concia
authors.affiliation: Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Novelli
authors.affiliation: Digestive, Colorectal, Oncologic and Minimally Invasive Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Rebecchi
authors.affiliation: CEIS, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Spandonaro
authors.affiliation: CEIS, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Alato
keywords: Antibiotics; Community-acquired intra-abdominal infections; Cost of care; Direct costs; Hospitalization