Klinikum Peine and Medical University Hannover, Peine, Germany.
Imperial College Healthcare NHS Trust, London, UK.
Int J Antimicrob Agents. 2014 Jul;44(1):56-64. doi: 10.1016/j.ijantimicag.2014.04.007. Epub 2014 May 16.
This retrospective observational medical chart review aimed to describe country-specific variations across Europe in real-world meticillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft-tissue infection (cSSTI) treatment patterns, antibiotic stewardship activity, and potential opportunities for early switch (ES) from intravenous (i.v.) to oral formulations and early discharge (ED) from hospital using standardised data collection and criteria and economic implications of these opportunities. Patients were randomly sampled from 12 countries (Austria, Czech Republic, France, Germany, Greece, Ireland, Italy, Poland, Portugal, Slovakia, Spain and the UK), aged ≥18 years, with documented MRSA cSSTI, hospitalised between 1 July 2010 and 30 June 2011, discharged alive by 31 July 2011. Of 1502 patients, 1468 received MRSA-targeted therapy. Intravenous-to-oral switch rates ranged from 2.0% to 20.2%, i.v. length of therapy from 10.1 to 18.6 days and hospital length of stay (LoS) from 15.2 to 25.0 days across Europe. Of 341 sites, 82.9% had antibiotic steering committees, 23.7% had i.v.-to-oral switch antibiotic protocols and 12.9% had ED protocols for MRSA cSSTI. ES and ED eligibility ranged from 12.0% (Slovakia) to 56.3% (Greece) and from 10% (Slovakia) to 48.2% (Portugal), respectively. Potential cost savings per ED-eligible patient ranged from €414 (Slovakia) to €2703 (France). MRSA cSSTI treatment patterns varied widely across countries, but further reductions in i.v. therapy, hospital LoS and associated costs could be realised. These data provide insight into clinical practice patterns across diverse European healthcare systems and identify potential opportunities for local clinicians and policy-makers to improve clinical care and cost-effectiveness of this therapeutic area.
本回顾性观察性医学图表回顾旨在描述欧洲各国耐甲氧西林金黄色葡萄球菌（MRSA）复杂皮肤和软组织感染（cSSTI）治疗模式、抗生素管理活动以及从静脉（i.v.）向口服制剂早期转换（ES）和提前出院（ED）的潜在机会，采用标准化数据收集和标准，并评估这些机会的经济意义。从 12 个国家（奥地利、捷克共和国、法国、德国、希腊、爱尔兰、意大利、波兰、葡萄牙、斯洛伐克、西班牙和英国）中随机抽取患者，年龄≥18 岁，有记录的 MRSA cSSTI，住院时间为 2010 年 7 月 1 日至 2011 年 6 月 30 日，2011 年 7 月 31 日前存活出院。在 1502 名患者中，1468 名接受了针对 MRSA 的治疗。静脉向口服转换率范围为 2.0%至 20.2%，静脉治疗时间为 10.1 至 18.6 天，住院时间为 15.2 至 25.0 天。在 341 个地点中，82.9%有抗生素管理委员会，23.7%有静脉向口服转换抗生素方案，12.9%有针对 MRSA cSSTI 的提前出院方案。ES 和 ED 的合格标准为 12.0%（斯洛伐克）至 56.3%（希腊）和 10%（斯洛伐克）至 48.2%（葡萄牙）。每位 ED 合格患者的潜在节省成本范围为 414 欧元（斯洛伐克）至 2703 欧元（法国）。MRSA cSSTI 的治疗模式在各国之间差异很大，但可以进一步减少静脉治疗、住院时间和相关成本。这些数据提供了对不同欧洲医疗保健系统中临床实践模式的深入了解，并确定了当地临床医生和政策制定者在改善该治疗领域的临床护理和成本效益方面的潜在机会。
