Resource Utilization of Adults Admitted to a Large Urban Hospital With Community-Acquired Pneumonia Caused by Streptococcus pneumoniae: Study Design
All can result in increased hospital length of stay, thereby significantly escalating costs. However, few cost-of-illness studies have attempted to evaluate the economic impact of penicillin susceptibility in patients with CAP caused by S pneumoniae. The primary objective of this study was to determine resource utilization and costs associated with the in-hospital treatment of CAP caused by S pneumoniae, as stratified by susceptibility to penicillin. A secondary objective was to determine other patient covariates that were predictive of a more costly hospital stay.
This was a retrospective cohort study of adult patients admitted to Hartford Hospital between 1999 and 2003 with documented CAP caused by S pneumoniae. Hartford Hospital is an 810-adult-bed, nonprofit, private, teaching hospital located in urban Hartford, CT. The institutional review board approved this study. Informed consent was not required since the study was retrospective in design and all protected health information was destroyed on completing data collection. Each patient received a subject number corresponding to a consecutively reviewed medical record and hospital bill. avandia online
All patients admitted to the hospital from January 1999 to January 2003 with respiratory or blood culture specimens testing positive for S pneumoniae were identified through the microbiology laboratory computer database. Examination of the medical records of these subjects was conducted to identify the cohort of patients who had the diagnosis of CAP caused by S pneumoniae. Patients were included if they were > 18 years old; had at least one sputum culture (with presence of < 10 squamous epithelial cells and > 25 polymorphonuclear cells per X 100 magnification field; or be obtained from semiquantitative culture) or two blood cultures positive for S pneumoniae; and had signs and symptoms consistent with the diagnosis of CAP including the presence of a new infiltrate on chest radiograph and at least two of the following within 1 day of the first positive culture: documentation of fever (> 38.0°C) or hypothermia (< 35.0°C); WBC count > 10,000/^L or > 15% bands or leukopenia (WBC < 4,500/^L); documentation of auscultory findings on pulmonary examination and/or evidence of pulmonary consolidation; documentation of new cough with or without sputum production; documentation of new-onset dyspnea or tachypnea; or hypoxemia with a Po2 < 60 mm Hg on room air.