The burden of initial empiric antibiotic failure on healthcare resources for hospitalized patients with complicated intra-abdominal infections in Greece

Abstract

Aim-Background: To estimate the impact of initial empiric antibiotic treatment failure on pharmacological and total healthcare costs in hospitalized patients with complicated intra–abdominal infections (cIAIs) in Greece. Methods: Adult patients with cIAIs hospitalized in 18 Greek surgical clinics over a 2-year period were included in this prospective observational study. Treatment failure was defined as the antibiotic addition or change (apart from intravenous to oral switch or de-escalation), the need for additional surgical procedure, or death. An average daily hospitalization cost was estimated based on the diagnosis at discharge and disease-related group mapping. Daily cost was then extrapolated for the incremental length of stay (LOS) associated with initial antibiotic failure. Costs included expenditure for additional intensive care unit (ICU) hospitalization and surgical interventions, and calculations followed a third party payer perspective (€2012). Results: A total of 201 patients with cIAIs met the inclusion criteria. Failure of the initial empiric antibiotic treatment was reported in 42.9% of subjects. The LOS was 21.9±16.4 and 8.9±4.5 days for “failed” versus “successful” patients, respectively. Total incremental per patient cost was estimated to be €3,761.56 inclusive of unsuccessful mean empiric antibiotic expenditure, the latter estimated at €220.06 per patient. Failure was related with previous antibiotic use, disease severity, antimicrobial resistance and co-morbidities, which in turn led to prolonged hospitalization, additional surgical procedures and hospitalization in the ICU. Conclusion: Subjects exhibiting failure of initial antibiotic treatment for cIAIs had a greater likelihood of requiring prolongation of hospitalization, increased use of healthcare resources and higher costs in an environment where resources are scarce.