Given the disparity in cost between inpatient and outpatient care, the IDSA/ATS community-acquired pneumonia (CAP) Guidelines recommend use of site-of-care severity of illness indicators to identify CAP patients who may be candidates for outpatient treatment. Despite this level 1 recommendation, there are limited data on US hospital community-acquired bacterial pneumonia (CABP) admissions patterns stratified by Pneumonia Severity Index (PSI) score and presence of comorbidities. This study described hospitalization and length of stay (LOS) patterns among adult patients with CABP who received ceftriaxone (CTX) and a macrolide (M) at admission in the MedAssets database. The primary objective was to quantify the proportion of admissions and associated hospital LOS among low risk patients (PSI score ≤ 90) where outpatient or short admission is advocated.
A retrospective study of patients hospitalized for CABP and in the MedAssets database during 2012-2015 was performed. Inclusion criteria: (1) age ≥ 18 years, (2) a primary diagnosis for CABP, (3) received CTX and a M on hospitalization day 1 or 2, and (3) ≥ 1-year enrollment before the index date. For patients with multiple hospitalizations for CABP during the study period, only the first episode was considered. Distribution of hospital admissions was stratified by PSI categories and Charlson Comorbidity Index (CCI). Both PSI and CCI were derived from diagnosis codes. Hospital LOS and mortality rates were tabulated across resulting PSI-CCI categories.
During the study period, 68,254 patients met inclusion criteria. Among hospitalized CABP patients, 35% had a PSI score ≤ 70 and 33% had a PSI score between 7190. The mean LOS for patients with a PSI score ≤ 70 and 7190 ranged between 5.26.6 days, depending on CCI score. Mortality was less than 0.5% for patients with PSI score ≤ 70 and 1.4% for patients with a 7190 PSI score.
More than two-thirds of hospitalized CABP patients who received CTX and a M had a PSI score ≤ 90. On average, hospital LOS was 56 days for CABP patients with PSI ≤ 90. These findings reflect the critical need to identify outpatient treatments that can effectively reduce hospital admissions.