Ninewells Hospital & Medical School, Dundee, UK.
Clin Microbiol Infect. 2014 Oct;20(10):993-1000. doi: 10.1111/1469-0691.12632. Epub 2014 May 15.
The objective of this study was to document pan-European real-world treatment patterns and healthcare resource use and estimate opportunities for early switch (ES) from intravenous (IV) to oral antibiotics and early discharge (ED) in hospitalized patients with methicillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft tissue infections (cSSTIs). This retrospective observational medical chart review study enrolled 342 physicians across 12 European countries who collected data from 1542 patients with documented MRSA cSSTI who were hospitalized (July 2010 to June 2011) and discharged alive (by July 2011). Data included clinical characteristics and outcomes, hospital length of stay (LOS), MRSA-targeted IV and oral antibiotic use, and ES and ED eligibility according to literature-based and expert-validated criteria. The most frequent initial MRSA-active antibiotics were vancomycin (50.2%), linezolid (15.1%), clindamycin (10.8%), and teicoplanin (10.4%). Patients discharged with MRSA-active antibiotics (n = 480) were most frequently prescribed linezolid (42.1%) and clindamycin (19.8%). IV treatment duration (9.3 ± 6.5 vs. 14.6 ± 9.9 days; p <0.001) and hospital LOS (19.1 ± 12.9 vs. 21.0 ± 18.2 days; p 0.162) tended to be shorter for patients switched from IV to oral treatment than for patients who received IV treatment only. Of the patients, 33.6% met ES criteria and could have discontinued IV treatment 6.0 ± 5.5 days earlier, and 37.9% met ED criteria and could have been discharged 6.2 ± 8.2 days earlier. More than one-third of European patients hospitalized for MRSA cSSTI could be eligible for ES and ED, resulting in substantial reductions in IV days and bed-days, with potential savings of €2000 per ED-eligible patient.
本研究的目的是记录欧洲范围内的真实世界治疗模式和医疗资源的使用情况，并评估耐甲氧西林金黄色葡萄球菌（MRSA）合并皮肤和软组织感染（cSSTI）住院患者中从静脉（IV）向口服抗生素转换（ES）和提前出院（ED）的机会。这项回顾性观察性医学图表审查研究纳入了来自欧洲 12 个国家的 342 名医生，他们从 1542 名确诊为 MRSA cSSTI 并住院（2010 年 7 月至 2011 年 6 月）且存活出院（截至 2011 年 7 月）的患者中收集数据。数据包括临床特征和结局、住院时间（LOS）、MRSA 靶向 IV 和口服抗生素的使用以及根据文献和专家验证的标准确定的 ES 和 ED 资格。初始使用的最常见的 MRSA 活性抗生素为万古霉素（50.2%）、利奈唑胺（15.1%）、克林霉素（10.8%）和替考拉宁（10.4%）。出院时使用 MRSA 活性抗生素的患者（n=480）最常被处方利奈唑胺（42.1%）和克林霉素（19.8%）。与仅接受 IV 治疗的患者相比，从 IV 转换为口服治疗的患者的 IV 治疗持续时间（9.3±6.5 vs. 14.6±9.9 天；p<0.001）和住院 LOS（19.1±12.9 vs. 21.0±18.2 天；p=0.162）往往更短。符合 ES 标准的患者占 33.6%，可以提前 6.0±5.5 天停止 IV 治疗，符合 ED 标准的患者占 37.9%，可以提前 6.2±8.2 天出院。超过三分之一的欧洲 MRSA cSSTI 住院患者符合 ES 和 ED 的标准，这将使 IV 天数和住院天数大幅减少，每位 ED 合格患者的潜在节省费用为 2000 欧元。
