Weihong Fan

Hospital admission patterns in adult patients with skin and soft tissue infections: Identification of potentially avoidable hospital admissions through a retrospective database analysis

Abstract Background: Despite the substantial hospitalization costs associated with the management of patients with skin and soft tissue infections (SSTIs) in the inpatient setting, there is limited guidance on patients who should be managed in the hospital relative to the outpatient setting. Studies have demonstrated that SSTI patients without major complications or comorbidities can be successfully managed in the outpatient setting. However, there are limited data on current hospital admission patterns for patients with SSTI. Objectives: Given this literature gap, this study described the current hospital admission patterns among adult patients with SSTI using data from a US hospital research database. Methods: To determine the subset of hospitalized SSTI patients who could likely be managed in the outpatient setting (potentially avoidable hospital admissions), the distribution of hospital admissions was categorized by infection severity and Charlson Comorbidity Index (CCI) score. Results: During the study observational period, there were 610,867 medical encounters across 520 hospitals. Of the 610,867, 125,743 (20.6%) were treated as inpatients. Nearly all patients with life-threatening conditions or systemic symptoms or a CCI score of 2 or greater were admitted. Among those with no life-threatening conditions and no systemic symptoms, admission rates exceeded 10 and 30% for patients with a CCI score of zero and 1, respectively. While the admissions rates for these patient populations were low, they accounted for nearly 60% of all admissions (75,255 of 125,743 hospital admissions). On average, patients with CCI score of zero or 1, independent of the presence of systemic symptoms, were treated in the hospital for about 4 days, costing

Economic Impact of Oritavancin for the Treatment of Acute Bacterial Skin and Skin Structure Infections in the Emergency Department or Observation Setting: Cost Savings Associated with Avoidable Hospitalizations

6000–

Single-Dose Oritavancin Treatment of Acute Bacterial Skin and Skin Structure Infections: SOLO Trial Efficacy by Eron Severity and Management Setting.

7000 on average. Conclusions: Given the cost associated with the management of patients with SSTIs in the inpatient setting, the findings highlight the critical need for healthcare systems to develop well-defined criteria for hospital admission based on presence of comorbid conditions and infection severity.

Daily cost of delay to adequate antibiotic treatment among patients surviving a hospitalization with community-onset Acinetobacter baumannii pneumonia or sepsis

PURPOSE Data indicate that acute bacterial skin and skin structure infection (ABSSSI) patients without major comorbidities can be managed effectively in the outpatient setting. Because most patients with ABSSSIs present to the emergency department, it is essential that clinicians identify candidates for outpatient treatment given the substantially higher costs associated with inpatient care. We examined the potential cost avoidance associated with shifting care from inpatient treatment with vancomycin to outpatient treatment with oritavancin for ABSSSI patients without major complications or comorbidities. METHODS A decision analytic, cost-minimization model was developed to compare costs of inpatient vancomycin versus outpatient oritavancin treatment of ABSSSI patients with few or no comorbidities (Charlson Comorbidity Index score ≤1) and no life-threatening conditions presenting to emergency department. Hospital discharge data from the Premier Research Database was used to determine the costs associated with inpatient vancomycin treatment. FINDINGS Mean costs for inpatient treatment with vancomycin ranged from

Use of Oritavancin in Moderate-to-Severe ABSSSI Patients Requiring IV Antibiotics: A U.S. Payer Budget Impact Analysis.

5973 to

Coadministration of Minocycline with Colistin in Critically Ill Patients Is Associated with Reduced Frequency of Acute Renal Failure: A Retrospective Cohort Analysis

9885, depending on Charlson Comorbidity Index score and presence of systemic symptoms. Switching an individual patient from inpatient vancomycin treatment to outpatient oritavancin treatment was estimated to save

Development and validation of a bedside instrument to predict carbapenem resistance among gram-negative pathogens in complicated urinary tract infections

1752.46 to

Multidrug resistance, inappropriate empiric therapy, and hospital mortality in Acinetobacter baumannii pneumonia and sepsis

6475.87 per patient, depending on Charlson Comorbidity Index score, presence of systemic symptoms, and use of observation status. Assuming some patients may be admitted to the hospital after treatment with oritavancin, it is estimated that up to 38.12% of patients could be admitted while maintaining budget neutrality. IMPLICATIONS This cost-minimization model indicates that use of oritavancin in the emergency department or observation setting is associated with substantial cost savings compared with inpatient treatment with vancomycin.

Carbapenem resistance, inappropriate empiric treatment and outcomes among patients hospitalized with Enterobacteriaceae urinary tract infection, pneumonia and sepsis

Introduction of new antibiotics enabling single-dose administration, such as oritavancin may significantly impact site of care decisions for patients with acute bacterial skin and skin structure infections (ABSSSI). This analysis compared the efficacy of single-dose oritavancin with multiple-dose vancomycin in patients categorized according to disease severity via modified Eron classification and management setting. SOLO I and II were phase 3 studies evaluating single-dose oritavancin versus 7–10 days of vancomycin for treatment of ABSSSI. Patient characteristics were collected at baseline and retrospectively analyzed. Study protocols were amended, allowing outpatient management at the discretion of investigators. In this post hoc analysis, patients were categorized according to a modified Eron severity classification and management setting (outpatient vs. inpatient) and the efficacy compared. Overall, 1910 patients in the SOLO trials were categorized into Class I (520, 26.5%), II (790, 40.3%), and III (600, 30.6%). Of the 767 patients (40%) in the SOLO trials who were managed entirely in the outpatient setting 40.3% were categorized as Class II and 30.6% were Class III. Clinical efficacy was similar between oritavancin and vancomycin treatment groups, regardless of severity classification and across inpatient and outpatient settings. Class III patients had lower response rates (oritavancin 73.3%, vancomycin 76.6%) at early clinical evaluation when compared to patients in Class I (82.6%) or II (86.1%); however, clinical cure rates at the post-therapy evaluation were similar for Class III patients (oritavancin 79.8%, vancomycin 79.9%) when compared to Class I and II patients (79.1–85.7%). Single-dose oritavancin therapy results in efficacy comparable to multiple-dose vancomycin in patients categorized according to modified Eron disease severity classification regardless of whether management occurred in the inpatient or outpatient setting. The Medicines Company, Parsippany, NJ, USA. ClinicalTrials.gov identifiers, NCT01252719 (SOLO I) and NCT01252732 (SOLO II).

Use of Oritavancin in Acute Bacterial Skin and Skin Structure Infections Patients Receiving Intravenous Antibiotics: A US Hospital Budget Impact Analysis

With >80% prevalence of multi-drug resistance, Acinetobacter baumannii (AB) poses a serious public health threat [1, 2]. We recently showed that inappropriate empiric therapy in the setting of community-onset AB pneumonia or sepsis is associated with 80% increase in hospital mortality [3]. The economic effects of delay in appropriate treatment are less clear. In a subgroup of the same cohort, we explored the cost associated with each day’s delay after obtaining index culture in instituting adequate therapy. The original cohort derived from 176 US hospitals in the Premier Research database 2009–2013 and consisted of all adult patients admitted with pneumonia or sepsis as principal diagnosis, or as a secondary diagnosis in the setting of respiratory failure, along with antibiotic administration within 2 days of admission [3]. Only culture-confirmed infections were included. Inappropriate empiric therapy was present if the antibiotic administered did not cover the organism or if coverage did not start within 2 days of obtaining the positive culture. For the current analysis, patients were excluded if they did not survive the hospitalization or never in the hospitalization received adequate treatment (an agent that covered AB). “Day 0” to adequate therapy was the day the positive culture was obtained. To assign costs to delay in adequate treatment, we categorized length of stay (LOS) into three groups, as number of days: (1) until the first index culture (“pre” time); (2) after the index culture until the first appropriate antibiotic (period of interest); and (3) after the first appropriate antibiotic until hospital discharge (“post” time). We adjusted for pre and post times so that the costs associated with them were not attributed to the period of interest. The model structure was a generalized linear model (GLM) with a logarithmic link to account for the skew in total costs. In addition to the time variables, as in our prior study, covariates included other parameters known by hospital day 2 [3]. Of the 1423 patients in the original cohort, 460 (32.3%) were included in the current analysis. Among these, only 201 (43.7%) received appropriate therapy on day 0, with the median time to adequate treatment 3 days (interquartile range 1, 5). In the GLM, each day’s delay in instituting adequate therapy added