Methods: Data was derived from the Premier Hospital Database, a US hospital administrative database containing hospital discharge data files, including diagnoses and procedures categorized by ICD-9 codes, medications, and cost data. Analysis was limited to 152 hospitals reporting microbiology data. Patients were included if admitted as inpatients January 1, 2009-June 30, 2014, had documented MDR AB with primary diagnosis of pneumonia or sepsis, received TIG or COL (but not both) treatment post-specimen date, and were treated for ≥3 days.
Results: 547 patients were eligible for analysis; 126 pneumonia (72 TIG, 54 COL) and 421 sepsis (292 TIG, 129 COL). Unadjusted, all-cause in-hospital mortality among pneumonia patients was 23.6% (TIG) and 18.5% (COL). Mean length of stay (LOS) was 18.26 and 21.98 days; mean hospital costs were $51,277 and $54,694; percent of patients requiring intensive care unit (ICU) was 76.4% vs. 59.3% for TIG and COL cohorts, respectively. Acute renal failure occurred in 12.5% of TIG and 25.9% of COL patients. 30-day readmission rates were 27.8% and 42.6% for patients treated with TIG and COL, respectively. Mortality among sepsis patients was 17.8% (TIG) and 21.7% (COL). Mean LOS was 21.70 and 22.41 days; mean hospital costs were $59,340 and $64,119; percentage of patients requiring ICU was 71.2% and 76.0%. Acute renal failure occurred in 7.5% of TIG and 14.0% of COL patients. 30-day readmission rates were 38.0% and 37.2% for patients treated with TIG and COL, respectively.
Conclusion: MDR AB patients treated with TIG or COL have high mortality and substantial resource utilization, including high costs, long LOS, and high readmission rates. Further research is needed to understand how treatment selection may impact healthcare outcomes and resource utilization in these high acuity patients.
The Medicines Company: