Given the disparity in cost between inpatient and outpatient care, the Infectious Diseases Society of America/American Thoracic Society community-acquired pneumonia (CAP) guidelines recommend use of site-of-care severity-of-illness indicators to identify CAP patients who may be candidates for outpatient treatment. Researchers undertook a retrospective study of patients hospitalized for community-acquired bacterial pneumonia (CABP) who were in the MedAssets database. Inclusion criteria were (1) age ≥18 years, (2) a primary diagnosis of CABP, (3) received ceftriaxone and a macrolide on day 1 or 2 of hospitalization, and (3) ≥1-year enrollment before the index date. For patients with multiple hospitalizations for CABP during the study period, only the first episode was considered. Distribution of hospital admissions was stratified by Pneumonia Severity Index (PSI) categories and Charlson Comorbidity Index (CCI). Both PSI and CCI were derived from diagnosis codes. Hospital length of stay and mortality rates were tabulated across resulting PSI-CCI categories.
During the study period, 32,917 patients met inclusion criteria. Among hospitalized patients with CABP, 35.2% had a PSI score ≤70 and 33.7% had a PSI score of 71 to 90. The mean length of stay for patients with a PSI score ≤70 and 71 to 90 ranged from 4.9 to 6.2 days, depending on CCI score. The 30-day mortality rates were <0.5% for patients with a PSI score ≤70 and 1.4% for patients with a 71 to 90 PSI score.
More than two-thirds of hospitalized patients with CABP who received ceftriaxone and a macrolide had a PSI score ≤90. These findings reflect the critical need to identify outpatient treatments that can effectively reduce hospital admissions.
Source: Lodise T, LaPensee K. IDWeek 2018. Abstract 1462.