Edelsberg John, Berger Ariel, Schell Scott, Mallick Rajiv, Kuznik Andreas, Oster Gerry
Policy Analysis Inc., Brookline, Massachusetts 02445, USA.
Surg Infect (Larchmt). 2008 Jun;9(3):335-47. doi: 10.1089/sur.2006.100.
Initial antibiotic therapy in hospitalized adults with complicated intra-abdominal infection (cIAI) usually is empiric. We explored the economic consequences of failure of such therapy in this patient population.
Using a large U.S. multi-institutional database, we identified all hospitalized adults admitted between April 1, 2003, and March 31, 2004; who had any cIAI; underwent laparotomy, laparoscopy, or percutaneous drainage of an intra-abdominal abscess ("surgery"); and received intravenous (IV) antibiotics. Initial therapy was characterized in terms of all IV antibiotics received, on the day of or one day before initial surgery. Antibiotic failure was designated on the basis of the need for reoperation or receipt of other IV antibiotics postoperatively. Switches to narrower spectrum agents and changes in regimen prior to discharge with no other evidence of clinical failure were not counted as antibiotic failures. Using multivariable linear regression, duration of IV antibiotic therapy, hospital length of stay, and total inpatient charges were compared between patients who did and did not fail initial therapy. Mortality was compared using multivariable logistic regression.
Among 6,056 patients who met the study entrance criteria, 22.4% failed initial antibiotic therapy. Patients who failed received an additional 5.6 days of IV antibiotic therapy (10.4 total days [95% confidence interval 10.1, 10.8] days vs. 4.8 total days [4.8, 4.9] for those not failing), were hospitalized an additional 4.6 days (11.6 total days [11.3, 11.9] vs. 6.9 total days [6.8, 7.0], respectively), and incurred $6,368 in additional inpatient charges ($16,520 [$16,131, $16,919] vs. $10,152 [$10,027, $10,280]) (all, p < 0.01). They also were more likely to die in the hospital (9.5% vs. 1.3%; multivariable odds ratio 3.58 [95% confidence interval 2.53, 5.06]).
Failure of initial IV antibiotic therapy in hospitalized adults with cIAIs is associated with longer hospitalization, higher hospital charges, and a higher mortality rate.
住院的复杂性腹腔内感染（cIAI）成年患者的初始抗生素治疗通常是经验性的。我们探讨了该患者群体中这种治疗失败的经济后果。
利用一个大型美国多机构数据库，我们确定了2003年4月1日至2004年3月31日期间所有住院的成年患者；患有任何cIAI；接受了剖腹手术、腹腔镜手术或腹腔脓肿的经皮引流（“手术”）；并接受了静脉（IV）抗生素治疗。初始治疗根据初始手术当天或前一天接受的所有静脉抗生素进行描述。抗生素治疗失败是根据术后再次手术的需要或接受其他静脉抗生素来确定的。在出院前改用窄谱药物和改变治疗方案且无其他临床失败证据的情况不算作抗生素治疗失败。使用多变量线性回归，比较了初始治疗失败和未失败患者的静脉抗生素治疗持续时间、住院时间和住院总费用。使用多变量逻辑回归比较死亡率。
在6056名符合研究入选标准的患者中，22.4%的患者初始抗生素治疗失败。治疗失败的患者额外接受了5.6天的静脉抗生素治疗（总共10.4天[95%置信区间10.1，10.8]天，而未失败患者为4.8天[4.8，4.9]天），住院时间额外增加了4.6天（分别为11.6天[11.3，11.9]天和6.9天[6.8，7.0]天），住院总费用额外增加了6368美元（16520美元[16131，16919]美元对10152美元[10027，10280]美元）（所有p<0.01）。他们在医院死亡的可能性也更高（9.5%对1.3%；多变量优势比3.58[95%置信区间2.53，5.06]）。
住院的cIAI成年患者初始静脉抗生素治疗失败与住院时间延长、住院费用增加和死亡率升高有关。
