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Resource Utilization of Adults Admitted to a Large Urban Hospital With Community-Acquired Pneumonia Caused by Streptococcus pneumoniae: Conclusion

Published in Pulmonary Function

These results conflict with other studies that have identified increased costs attributed to infection with numerous resistant organisms, including S pneumoniae. In particular, our results conflict with a retrospective, cohort study of similar size but different time period by Klepser and colleagues; these investigators evaluated health-care resource utilization for the treatment of penicillin-susceptible and penicillin-nonsusceptible isolates of S pneumoniae and found that total hospitalization costs were significantly greater for patients infected with penicillin nonsusceptible isolates ($10,309.25 vs $7,801.54, p = 0.0006). The primary reason for the higher cost was a greater length of stay among the nonsusceptible group (14 days vs 10 days, p < 0.05). Length of stay in general was much lower for patients in our study (median, 5 days) and not different between susceptible and nonsusceptible groups. It is most likely that the advances in understanding the time frame and clinical characteristics of the stable CAP patient in the current era (2000 to present) have dramatically reduced the duration of hospital stay compared with when the study by Klepser et al was conducted (1995 to 1998), therefore making it more difficult to find a difference if one were to exist. canadian neighbor pharmacy
Another potential reason for the discordance between our results and others is due to the fact that we defined groups according to penicillin susceptibility, yet only one patient actually received penicillin in our study. Instead, most were treated with second-generation or third-generation cephalosporins in combination with a macrolide or with fluoroquinolone monotherapy. Later-generation cephalosporins and fluoroquinolones are known to be more effective against S pneumoniae harboring intermediate-level resistance to penicillin, as well as isolates that are fully resistant with an MIC of 2 ^g/mL.’2′ Р-Lactam efficacy is only questioned when the penicillin MIC is > 4 ^g/mL. In the study by Klepser et al, patients also received a variety of different antibiotic cocktails; however, it was not possible to determine which Р-lactams were used, or if any were penicillin. We had susceptibility data reported solely for penicillin, and only in isolated cases did the microbiology laboratory have data for other antibiotics. This made it difficult to associate antibiotic resistance specific to the antibiotic received with that of hospital cost or length of stay. It also made it impossible for us to evaluate the appropriateness of empiric antibiotic therapy based on in vitro susceptibilities and its effect on the dependent variables. Therefore, from these data we cannot make a final conclusion regarding an association between antibiotic resistance among S pneumoniae and increased costs, except that penicillin resistance matters little in light of few patients still receiving this agent empirically. These data do, however, suggest that differentiation among S pneumoniae using solely penicillin susceptibility may not be sufficient.