Resource use in patients hospitalized with complicated skin and soft tissue infections in Europe and analysis of vulnerable groups: the REACH study

Abstract

Background:

Hospitalized patients with complicated skin and soft tissue infections (cSSTI) present a substantial economic burden, and resource use can vary according to the presence of comorbidities, choice of antibiotic agent, and the requirement for initial treatment modification. REACH (NCT01293435) was a retrospective, observational study aimed at collecting empirical data on current (year 2010–2011) management strategies of cSSTI in 10 European countries.

Methods:

Patients (n = 1995) were aged ≥18 years, hospitalized with a cSSTI and receiving intravenous antibiotics. Data, collected via electronic Case Report Forms, detailed patient characteristics, medical history, disease characteristics, microbiological diagnosis, disease course and outcomes, treatments before and during hospitalization, and health resource consumption.

Results:

For the analysis population, mean length of hospital stay (including duration of hospitalizations for patients with recurrences) was 18.5 days (median 12.0). Increased length of hospital stay was found for patients with comorbidities vs those without (mean = 19.9; [median = 14.0] days vs 13.3 [median = 8.0] days), for patients with methicillin-resistant Staphylococcus aureus compared with patients with methicillin-sensitive S. aureus (mean = 27.7 [median = 19.5] days vs 18.4 [median = 13.0] days) and for patients requiring surgery (mean = 24.4 [median = 16.0] days vs 15.0 [median = 11.0] days). Patients requiring modification of their initial antibiotic treatment had an associated increase in mean length of hospital stay of 10.9 days (median = 6.5) and additional associated hospital resource use. A multivariate analysis confirmed the association of nosocomial infections, comorbidities, directed treatment, recurrent infections, diabetes, recent surgery, and older age (≥65 years), with longer hospital stay.

Conclusions:

This study provides real-life data on factors that are expected to impact length of hospital stay, to guide clinical decision-making to improve outcomes, and reduce resource use in patients with cSSTI.

Keywords::

• Anti-bacterial agents
• Complicated skin and soft tissue infections
• Europe
• Resource use
• Retrospective study
• Vulnerable groups

Transparency

Declaration of funding

This study was supported and funded by AstraZeneca.

Declaration of financial/other relationships

JM and EP are employees of AstraZeneca. HO has received research grants, speaking invitations, and conference invitations from Astellas, AstraZeneca, Gilead, MSD, Pfizer, and TEVA, and consultancy fees from AstraZeneca, Gilead, MSD, and TEVA. FB has received research grants from GSK, Chiesi, Zambon, and Pfizer, congress lecture fees from GSK, Chiesi, Pfizer, and Abbott, and consultancy fees from AstraZeneca, GSK, and Pfizer. KMB has received consultancy fees from Celgene Corporation, AstraZeneca, Worldwide Clinical Trials, Integrium LLC, Cypress Pharmaceuticals, Sigma-Tau Pharmaceuticals, Outcomes Research (now owned by Quintiles), Multiple Myeloma Research Foundation, MedImmune, ACT Oncology, and BioSoteria. JG has received research grants, speaking invitations, and conference invitations from Bayer, GSK, AstraZeneca, Novartis, Vifor Pharma, Pfizer, and Astellas, and has recent or ongoing consultancies with GSK, Bayer, Pfizer, Novartis, Vifor Pharma, Janssen Cilag, AstraZeneca, Astellas, Theravance, and Durata. JME Peer Reviewers on this manuscript have no relevant financial relationships to disclose.

Acknowledgments

The authors thank Dr Manda Gent from MediTech Media Ltd for medical writing support, funded by AstraZeneca.