TY - JOUR
T1 - A clinical pathway for community-acquired pneumonia
T2 - An observational cohort study
AU - Frei, Christopher R.
AU - Bell, Allison M.
AU - Traugott, Kristi A.
AU - Jaso, Terry C.
AU - Daniels, Kelly R.
AU - Mortensen, Eric M.
AU - Restrepo, Marcos I.
AU - Oramasionwu, Christine U.
AU - Ruiz, Andres D.
AU - Mylchreest, William R.
AU - Sikirica, Vanja
AU - Raut, Monika R.
AU - Fisher, Alan
AU - Schein, Jeff R.
N1 - Funding Information:
Funding was provided by Ortho-McNeil Janssen Scientific Affairs, LLC. The study was designed locally and all data were collected and analyzed by the local investigators. The sponsor set no limitations on study content. CRF is supported by the United States National Institutes of Health in the form of a KL2 career development award (KL2 RR025766).
PY - 2011/7/6
Y1 - 2011/7/6
N2 - Background: 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.Methods: 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.Results: 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).Conclusions: Pathway antibiotics were associated with improved patient survival, hospital LOS, and total hospital cost for patients admitted to the hospital with CAP.
AB - Background: 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.Methods: 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.Results: 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).Conclusions: Pathway antibiotics were associated with improved patient survival, hospital LOS, and total hospital cost for patients admitted to the hospital with CAP.
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U2 - 10.1186/1471-2334-11-188
DO - 10.1186/1471-2334-11-188
M3 - Article
C2 - 21733161
AN - SCOPUS:79959881170
SN - 1471-2334
VL - 11
JO - BMC Infectious Diseases
JF - BMC Infectious Diseases
M1 - 188
ER -