Nicolau David P P
Center for Anti-Infective Research and Development, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA.
J Manag Care Pharm. 2009 Mar;15(2 Suppl):S12-7. doi: 10.18553/jmcp.2009.15.s2.12.
The overall health care costs for managing patients with community-acquired pneumonia (CAP) in U.S. hospitals is burdensome. While pharmacy costs comprise only a minor proportion of these costs, hospital length of stay (LOS) is the greatest contributor. Infections due to antimicrobial-resistant pathogens are also associated with increased overall health care cost. Therefore, strategies that aim to minimize antimicrobial resistance and reduce hospital LOS may have the greatest impact in reducing overall health care costs in managing patients with CAP.
To evaluate how antimicrobial resistance can impact health care costs associated with CAP and review strategies to minimize the risk of resistance development while promoting appropriate antimicrobial therapy (including optimized dosing) and decreasing hospital LOS.
Antimicrobial resistance can increase the risk of clinical failure and result in higher overall health care costs. Further development of antimicrobial resistance during therapy should, therefore, be minimized. This can be achieved through optimized antimicrobial dosing strategies- using a higher dose of concentration-dependent agents or prolonged infusion of time-dependent agents - that increase the probability of attaining pharmacokinetic-pharmacodynamic targets for eradication of the pathogen and hence successful clinical outcomes. Decreasing LOS must be a priority when attempting to reduce hospital costs. Active intravenous-to-oral switch therapy has been shown to effectively reduce LOS. Appropriate short-course regimens may also offer the opportunity for effective treatment while reducing or eliminating unnecessary antimicrobial exposure that not only reduces the potential for drug-related adverse events, but may also minimize the selection of resistant organisms.
Clinical failure and antimicrobial resistance can significantly increase the cost of managing patients with CAP, primarily by increasing LOS. Therefore, strategies should be employed to minimize the risk of resistance development and reduce LOS. These include early appropriate therapy, optimized dosing based on pharmacodynamic principles, and efficient IV-to-PO switch therapy when appropriate.
在美国医院中，管理社区获得性肺炎（CAP）患者的总体医疗费用负担沉重。虽然药房费用仅占这些费用的一小部分，但住院时间（LOS）是最大的费用贡献因素。抗菌药物耐药病原体引起的感染也与总体医疗费用增加有关。因此，旨在尽量减少抗菌药物耐药性并缩短住院时间的策略可能对降低CAP患者管理中的总体医疗费用产生最大影响。
评估抗菌药物耐药性如何影响与CAP相关的医疗费用，并审查在促进适当抗菌治疗（包括优化给药剂量）和缩短住院时间的同时尽量降低耐药性发展风险的策略。
抗菌药物耐药性会增加临床治疗失败的风险，并导致更高的总体医疗费用。因此，应尽量减少治疗期间抗菌药物耐药性的进一步发展。这可以通过优化抗菌药物给药策略来实现——使用更高剂量的浓度依赖性药物或延长时间依赖性药物的输注时间——这会增加实现药代动力学-药效学目标以根除病原体并因此获得成功临床结果的可能性。在试图降低医院成本时，缩短住院时间必须是优先事项。积极的静脉给药至口服转换治疗已被证明可有效缩短住院时间。适当的短疗程方案也可能提供有效治疗的机会，同时减少或消除不必要的抗菌药物暴露，这不仅会降低药物相关不良事件的可能性，还可能最大限度地减少耐药菌的选择。
临床治疗失败和抗菌药物耐药性会显著增加CAP患者的管理成本，主要是通过延长住院时间。因此，应采取策略尽量降低耐药性发展的风险并缩短住院时间。这些策略包括早期适当治疗、基于药效学原理的优化给药剂量，以及在适当时进行有效的静脉给药至口服转换治疗。
