Methods: This is a retrospective cohort of adult hospitalized pts in the Premier Healthcare Database (PHD) from 1/1/15-6/30/17, who received ≥ 2 consecutive days of C/T. The PHD contains demographic, clinical and healthcare resource utilization. Microbiology data are available from a subset of PHD hospitals. Multidrug resistance (MDR) was resistance or intermediate to 1 or more agents in at least 3 classes. Outcomes included hospital length of stay (LOS), 30-day mortality, and readmissions (all cause and infection-related).
Results: A total of 1490 patients across 253 hospitals met study criteria. Mean age was 59.1 ± 17.5 years, 57% were male, and 65% were Caucasian. The most common comorbidities were chronic pulmonary disease (36%), renal disease (34%), and congestive heart failure (25%). 27% of patients had a prior hospitalization within 30 days. The mean Charlson score was 3 ± 2.4. Over half (55%) of pts were in the ICU, 49% were mechanically ventilated and 15% were on dialysis. Within the 259 patients with microbiology data, the most prevalent pathogen was Pseudomonas aeruginosa (78%). The median (IQR) number of days from admission to first day of C/T was 6 (2-15). Patients received a median (IQR) 7 (4-11) days of C/T. The median (IQR) LOS after the first dose of C/T was 10 (6-18) days. The 30 day mortality rate was 9%. All cause and infection related readmissions were 17% and 9%, respectively.
Conclusion: Most of C/T’s usage was among critically ill, complex patients treated in the intensive care unit with P. aeruginosa. In spite of the complex nature of these pts, the outcomes among pts treated with C/T were positive and provides needed real world evidence. Further studies with a comparator group will allow further interpretation.
J. Gundrum, Merck: Research Contractor , Research grant .
T. P. Lodise Jr., Motif BioSciences: Board Member , Consulting fee .