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

Published in Pulmonary Function

Resource Utilization of Adults Admitted to a Large Urban Hospital With Community-Acquired Pneumonia Caused by Streptococcus pneumoniae: DiscussionEighty-eight patients (52%) in our cohort met the definition of unexplained delayed discharge. Excluding patients who died in the hospital, the median length of stay was significantly longer in patients with unexplained delayed discharge: 7 days (25th to 75th percentile, 4 to 11 days) vs 5 days (25th to 75th percentile, 3.25 to 7 days) [p = 0.005]. There was no apparent difference in age, comorbidities, or PSI score among patients meeting the definition of unexplained delayed discharge and those who did not. Additionally, penicillin susceptibility had no effect on patients with unexplained delayed discharge (p = 0.847). The addition of delayed discharge improved the coefficient of determination (r2) significantly in both models. http://medicine-against-diabetes.net/
Health-care costs attributed to managing CAP in the United States are now estimated to be > $10 billion annually, with the majority of these costs credited to treatment in the hospital.- Therefore, studies aimed at identifying key factors associated with increased health-care costs are essential to improving cost-effectiveness and quality of care. In the current study, we assessed the factors predictive of increasing hospital costs and length of stay for patients admitted with pneumococcal pneumonia to a large, urban, private, teaching hospital over a 5-year period. We observed that hospital bed costs accounted for > 50% of the total resources utilized and that admission to the ICU, neoplasm, and an unexplained delayed discharge were independently associated with total hospital costs and extended length of stay. Additionally, end of hospital mortality was a significant predictor of costs, and the presence of CHF and bacteremia were positive predictors of length of stay.
However, the primary objective of this study was to determine if resistance to penicillin among S pneumoniae had an adverse effect on hospital costs or length of stay. Total median hospital cost for patients infected with penicillin susceptible isolates was $8,503, compared with $9,441 for those infected with nonsusceptible isolates (p = 0.617). As a result, penicillin susceptibility was not a significant variable in any of the multivariate regression models predicting hospital costs or length of stay. The conclusions remained similar even when the definition of penicillin nonsusceptibility was changed to fully resistant (MIC > 2 ^g/mL) vs susceptible/intermediate (data not shown), or when the total costs were compared for susceptible, intermediate, and resistant independently ($8,503 vs $6,347 vs $10,809, respectively; p = 0.477).