Clinical response and hospital costs associated with the empirical use of vancomycin and linezolid for hospital-acquired pneumonia in a Chinese tertiary care hospital: a retrospective cohort study

Abstract

Aims

To evaluate clinical outcomes and allocation of hospital costs associated with empirical use of vancomycin or linezolid for hospital-acquired pneumonia (HAP) in the People’s Republic of China.

Methods

Hospital episodes including HAP treated by vancomycin or linezolid between 2008 and 2012 in a Chinese tertiary care hospital were retrospectively identified from hospital administrative databases. Propensity score methods created best-matched pairs for the antibiotics. The matched pairs were used for adjusted comparisons on clinical response and allocation of hospital costs. Multiple regression analyses adjusting residual imbalance after matching were performed to confirm adjusted comparisons.

Results

Sixty matched pairs were created. Adjusted comparisons between vancomycin and linezolid showed similar clinical response rates (clinical cure: 30.0% versus 31.7%, respectively; P=0.847; treatment failure: 55.0% versus 45.0%, respectively; P=0.289) but a significantly lower in-hospital mortality rate for vancomycin (3.3% versus 18.3%, respectively; P=0.013). After further adjusting for the imbalanced variables between matched treatment groups, the risks of treatment failure associated with the two antibiotics were comparable (odds ratio: 1.139; P=0.308) and there was a nonsignificant trend of lower risk of in-hospital mortality associated with vancomycin (odds ratio: 0.186; P=0.055). The total hospital costs associated with vancomycin had a nonsignificant trend of being lower, likely because of its significantly lower acquisition costs (median: RMB 2,880 versus RMB 8,194; P<0.001; 1 RMB =0.16 USD).

Conclusion

In tertiary care hospitals in the People’s Republic of China, empirical treatment of patients with HAP with vancomycin had a comparable treatment failure rate but likely had a lower in-hospital mortality rate when compared with linezolid. Vancomycin also costs significantly less for drug acquisition than linezolid when treating HAP empirically.

Keywords:

• methicillin-resistant Staphylococcus aureus
• treatment failure
• mortality
• antibiotics

Acknowledgments

This study was funded by an unrestricted Health Outcomes Research grant of Eli Lilly China.

Author contributions

Y Song and Y Yang formulated the research idea and developed the study protocol. Y Song, Y Yang, W Chen, W Liu, K Wang, X Li, K Wang, M Papadimitropoulos and W Montgomery contributed to the study design, data analysis and interpretation of the results. Y Song supervised the data collection from the hospital administrative database. All authors participated in the drafting and review of the manuscript and agree to be accountable for all aspects of the work.

Disclosure

Y Song received honorariums for travels and expenses on the study. W Liu, K Wang, X Li, M Papadimitropoulos, and W Montgomery are employees of Eli Lilly. Contributions from Y Yang and K Wang were made whilst they were employees of Eli Lilly. W Chen received a project consulting fee from Eli Lilly to compensate for his time on this project.