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Open Access Highly Accessed Research article

Influence of real-world characteristics on outcomes for patients with methicillin-resistant Staphylococcal skin and soft tissue infections: a multi-country medical chart review in Europe

Dilip Nathwani1, Christian Eckmann2, Wendy Lawson3, Caitlyn T Solem4, Shelby Corman4, Jennifer M Stephens4*, Cynthia Macahilig5, Damien Simoneau6, Richard Chambers7, Jim Z Li8 and Seema Haider9

Author Affiliations

1 Ninewells Hospital and Medical School, Ward 42, East Block, Dundee DD19SY, UK

2 Klinikum Peine, Academic Hospital of Medical University Hannover, Virchowstrasse 8 h, D-31226 Peine, Germany

3 Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK

4 Pharmerit International, 4350 East West Highway, Suite 430, Bethesda, MD 20814, USA

5 Medical Data Analytics, 4 Gatehall Drive, 2nd Floor, Parsippany, NJ 07054, USA

6 Pfizer International Operations, 23-25 avenue du Dr Lannelongue, Paris 75668, France

7 Pfizer Inc, 500 Arcola Road, Collegeville, PA 19426, USA

8 Pfizer Inc, 10646 Science Center Drive, San Diego, CA 92121, USA

9 Pfizer Inc, Eastern Point Road, Groton, CT 06340, USA

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BMC Infectious Diseases 2014, 14:476  doi:10.1186/1471-2334-14-476

Published: 2 September 2014

Abstract

Background

Patient-related (demographic/disease) and treatment-related (drug/clinician/hospital) characteristics were evaluated as potential predictors of healthcare resource use and opportunities for early switch (ES) from intravenous (IV)-to-oral methicillin-resistant Staphylococcus aureus (MRSA)-active antibiotic therapy and early hospital discharge (ED).

Methods

This retrospective observational medical chart study analyzed patients (across 12 European countries) with microbiologically confirmed MRSA complicated skin and soft tissue infections (cSSTI), ≥3 days of IV anti-MRSA antibiotics during hospitalization (July 1, 2010-June 30, 2011), and discharged alive by July 31, 2011. Logistic/linear regression models evaluated characteristics potentially associated with actual resource use (length of IV therapy, length of hospital stay [LOS], IV-to-oral antibiotic switch), and ES and ED (using literature-based and expert-verified criteria) outcomes.

Results

1542 patients (mean ± SD age 60.8 ± 16.5 years; 61.5% males) were assessed with 81.0% hospitalized for MRSA cSSTI as the primary reason. Several patient demographic, infection, complication, treatment, and hospital characteristics were predictive of length of IV therapy, LOS, IV-to-oral antibiotic switch, or ES and ED opportunities. Outcomes and ES and ED opportunities varied across countries. Length of IV therapy and LOS (r = 0.66, p < 0.0001) and eligibilities for ES and ED (r = 0.44, p < 0.0001) showed relatively strong correlations. IV-to-oral antibiotic switch patients had significantly shorter length of IV therapy (−5.19 days, p < 0.001) and non-significantly shorter LOS (−1.86 days, p > 0.05). Certain patient and treatment characteristics were associated with increased odds of ES (healthcare-associated/ hospital-acquired infection) and ED (patient living arrangements, healthcare-associated/ hospital-acquired infection, initiating MRSA-active treatment 1–2 days post cSSTI index date, existing ED protocol), while other factors decreased the odds of ES (no documented MRSA culture, ≥4 days from admission to cSSTI index date, IV-to-oral switch, IV line infection) and ED (dementia, no documented MRSA culture, initiating MRSA-active treatment ≥3 days post cSSTI index date, existing ES protocol).

Conclusions

Practice patterns and opportunity for further ES and ED were affected by several infection, treatment, hospital, and geographical characteristics, which should be considered in identifying ES and ED opportunities and designing interventions for MRSA cSSTI to reduce IV days and LOS while maintaining the quality of care.

Keywords:
IV-to-oral antibiotic switch; Length of stay; Clinical criteria; Antibiotic therapy