Global Health Outcomes Strategy & Research, Allergan plc, Irvine, California.
Real-World Evidence, Evidera, Waltham, Massachusetts.
Am J Med Sci. 2019 Feb;357(2):103-110. doi: 10.1016/j.amjms.2018.11.009. Epub 2018 Nov 22.
To examine the clinical and economic burdens associated with delayed receipt of appropriate therapy among patients with Gram-negative bacteria (GNB) infections, stratified by antibiotic resistance status.
Retrospective analysis using the Premier Hospital Database. Adult admissions (July 2011-September 2014) with evidence of complicated urinary tract infection, complicated intra-abdominal infection, hospital-associated pneumonia, or bloodstream infection, length of stay (LOS) ≥1 days and a positive GNB culture from a site consistent with infection type (culture draw date = index date) were identified and stratified by antibiotic susceptibility to index pathogens. Delayed appropriate therapy was defined as no receipt of antibiotic(s) with relevant microbiological activity on or within 2 days of index date. Inverse probability weighting and multivariate regression analyses were used to estimate the association between delayed appropriate therapy and outcomes. Generalized linear models were used to evaluate postindex duration of antibiotic therapy, LOS and total in-hospital costs. Logistic models were used to evaluate discharge destination and in-hospital mortality/discharge to hospice.
A total of 56,357 patients with GNB infections were identified (resistant, n = 6,055; susceptible, n = 50,302). Delayed appropriate therapy was received by 2,800 (46.2%) patients with resistant and 16,585 (33.0%) patients with susceptible infections. Using multivariate analysis, delayed appropriate therapy was associated with worse outcomes including ∼70% increase in LOS, ∼65% increase in total in-hospital costs and ∼20% increase in the risk of in-hospital mortality/discharge to hospice, regardless of susceptibility status.
Our results suggest that outcomes in patients with GNB infections, regardless of resistance status, significantly improve if timely appropriate therapy can be provided.
本研究旨在探讨革兰氏阴性菌（GNB）感染患者接受适当治疗的时间延迟与临床和经济负担的关系，并按抗生素耐药情况进行分层。
使用 Premier 医院数据库进行回顾性分析。纳入 2011 年 7 月至 2014 年 9 月间符合以下条件的成年住院患者：存在复杂性尿路感染、复杂性腹腔内感染、医院获得性肺炎或血流感染，住院时间（LOS）≥1 天，且从与感染类型一致的部位（培养物采集日期=索引日期）获得了 GNB 阳性培养物。将延迟接受适当治疗定义为在索引日期或之后 2 天内未接受具有相关微生物学活性的抗生素治疗。采用逆概率加权和多变量回归分析来评估延迟接受适当治疗与结局之间的关系。采用广义线性模型来评估索引日后抗生素治疗持续时间、LOS 和总住院费用。采用逻辑模型来评估出院去向和院内死亡率/转至临终关怀。
共纳入 56357 例 GNB 感染患者（耐药组 n=6055 例，敏感组 n=50302 例）。6055 例耐药感染和 16585 例敏感感染患者中，分别有 2800（46.2%）例和 16585（33.0%）例接受了延迟适当治疗。多变量分析结果显示，无论耐药状态如何，延迟接受适当治疗与较差的结局相关，包括 LOS 延长约 70%、总住院费用增加约 65%以及院内死亡率/转至临终关怀的风险增加约 20%。
无论耐药状态如何，如果能及时提供适当的治疗，GNB 感染患者的结局都会显著改善。
