Hospital length of stay in patients with methicillin-resistant Staphylococcus aureus infections: retrospective analysis of a clinical study comparing tigecycline and vancomycin
Abstract number: 1733_338
Mallick R., Sun S.
Objective: Using data from a recent clinical study, to investigate which presenting characteristics were risk factors for prolonged length of stay (LOS) in hospitalised patients treated for serious infections involving MRSA.
Method: For this analysis, data from patients with MRSA in a multinational, double-blind clinical study conducted in patients with confirmed serious infections involving resistant Gram-positive pathogens (MRSA and vancomycin-resistant enterococci [VRE]) was extracted. In the study, patients with MRSA were randomly assigned in a 3:1 ratio to receive IV tigecycline or vancomycin. Treatment duration was to be 728 days, depending on site and severity of the infection. Hospital length of stay was based on additional systemic evaluation. We (a) summarised baseline characteristics and (b) estimated multiple regression models adjusting for hospital death and study discontinuation as necessary to identify risk factors for prolonged LOS.
Results: Among patients with MRSA infections who met minimal disease criteria (n = 133) and had complete hospitalisation data (n = 131), diabetes (20.7%) and peripheral vascular disease (PVD) (17.4%) were leading co-morbidities. Complicated skin and skin structure infections (69.5%), complicated intra-abdominal infections (16.0%) and bacteraemia including catheter-related bacteraemia (9.9%) constituted the most common infection types. Mean APACHE severity score was 7.9; 9.9% of patients had an APACHE score >15. Mean duration of IV antibiotic therapy was 12.1 days, mean LOS was 15.0 days, re-hospitalisation rate was 9.2%, mortality rate was 3.8%. Bacteraemia (+4.8 days; p = 0.0014) and peripheral vascular disease (+2.7 days; p = 0.029) were notably associated with prolonged IV treatment duration. An APACHE score >15 was associated with a substantial impact (+15.8 days; p < 0.0001) on hospital LOS. There was no significant difference between the tigecycline and vancomycin groups in IV treatment duration, LOS, re-hospitalisation rate or mortality rate.
Conclusions: In this retrospective analysis of a clinical study in patients with selected serious infections involving MRSA, bacteraemia and peripheral vascular disease emerged as presenting risk factors for prolonged IV antibiotic treatment, and an APACHE score >15 for prolonged hospitalisation; there were no significant differences between tigecycline and vancomycin.
|Session name:||European Society of Clinical Microbiology and Infectious Diseases|
|Location:||ICC, Munich, Germany|
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