College of Pharmacy, The University of Texas at Austin, 1 University Station A1900, Austin, TX 78712, USA.
BMC Infect Dis. 2011 Jul 6;11:188. doi: 10.1186/1471-2334-11-188.
Six hospitals instituted a voluntary, system-wide, pathway for community acquired pneumonia (CAP). We proposed this study to determine the impact of pathway antibiotics on patient survival, hospital length of stay (LOS), and total hospital cost.
Data were collected for adults from six U.S. hospitals with a principal CAP discharge diagnosis code, a chest infiltrate, and medical notes indicative of CAP from 2005-2007. Pathway and non-pathway cohorts were assigned according to antibiotics received within 48 hours of admission. Pathway antibiotics included levofloxacin 750 mg monotherapy or ceftriaxone 1000 mg plus azithromycin 500 mg daily. Multivariable regression models assessed 90-day mortality, hospital LOS, total hospital cost, and total pharmacy cost.
Overall, 792 patients met study criteria. Of these, 505 (64%) received pathway antibiotics and 287 (36%) received non-pathway antibiotics. Adjusted means and p-values were derived from Least Squares regression models that included Pneumonia Severity Index risk class, patient age, heart failure, chronic obstructive pulmonary disease, and admitting hospital as covariates. After adjustment, patients who received pathway antibiotics experienced lower adjusted 90-day mortality (p = 0.02), shorter mean hospital LOS (3.9 vs. 5.0 days, p < 0.01), lower mean hospital costs ($2,485 vs. $3,281, p = 0.02), and similar mean pharmacy costs ($356 vs. $442, p = 0.11).
Pathway antibiotics were associated with improved patient survival, hospital LOS, and total hospital cost for patients admitted to the hospital with CAP.
六家医院制定了一个自愿的、系统范围的社区获得性肺炎（CAP）通路。我们提出这项研究是为了确定通路抗生素对患者生存率、住院时间（LOS）和总住院费用的影响。
从 2005 年至 2007 年，我们在美国六家医院收集了主要 CAP 出院诊断代码、胸部浸润和表明 CAP 的医疗记录的成年人数据。根据入院后 48 小时内接受的抗生素，将通路和非通路队列分配。通路抗生素包括左氧氟沙星 750mg 单药治疗或头孢曲松 1000mg 加阿奇霉素 500mg 每日一次。多变量回归模型评估 90 天死亡率、住院 LOS、总住院费用和总药房费用。
共有 792 名患者符合研究标准。其中，505 名（64%）接受了通路抗生素，287 名（36%）接受了非通路抗生素。调整后的均值和 p 值来自最小二乘回归模型，该模型包括肺炎严重指数风险类别、患者年龄、心力衰竭、慢性阻塞性肺疾病和入院医院作为协变量。调整后，接受通路抗生素的患者 90 天死亡率较低（p = 0.02），住院时间更短（3.9 天 vs. 5.0 天，p < 0.01），总住院费用更低（2485 美元 vs. 3281 美元，p = 0.02），药房费用相似（356 美元 vs. 442 美元，p = 0.11）。
对于因 CAP 住院的患者，通路抗生素与提高患者生存率、住院 LOS 和总住院费用有关。
