Clinical Utility and Cost Effectiveness of Long-Acting Lipoglycopeptides Used in Deep-Seated Infections among Patients with Social and Economic Barriers to Care

The use of long-acting lipoglycopeptides (LaLGPs) in serious, deep-seated infections is of increasing interest. The purpose of this study is to evaluate the economic and clinical utility of LaLGPs in patients requiring protracted antibiotic courses who are not ideal candidates for oral transition or outpatient parenteral antibiotic therapy (OPAT). This is a retrospective, observational, matched cohort study of adult patients who received a LaLGP. Patients were matched 1:1 to those who received standard of care (SOC). Cost effectiveness was evaluated as total healthcare-related costs between groups. Clinical failure was a composite endpoint of mortality, recurrence, or need for extended antibiotics beyond planned course within 90 days of initial infection. There was no difference in clinical failure between the two cohorts (22% vs. 30%; p = 0.491). Six patients in the SOC cohort left against medical advice (AMA) prior to completing therapy. Among those who did not leave AMA, receipt of LaLGPs resulted in a decreased hospital length of stay by an average of 13.6 days. The average total healthcare-related cost of care was USD 295,589 in the LaLGP cohort compared to USD 326,089 in the SOC cohort (p = 0.282). Receipt of LaLGPs may be a beneficial treatment option for patients with deep-seated infections and socioeconomic factors who are not candidates for oral transition or OPAT.

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Long-Acting Lipoglycopeptides: “Lineless Antibiotics” for Serious Infections in Persons Who Use Drugs

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz274 ◽

2019 ◽

Vol 6 (7) ◽

Cited By ~ 16

Author(s):

Taylor Morrisette ◽

Matthew A Miller ◽

Brian T Montague ◽

Gerard R Barber ◽

R Brett McQueen ◽

...

Keyword(s):

Clinical Judgment ◽

Cost Savings ◽

Standard Of Care ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Serious Infections ◽

Reduced Rate ◽

Long Acting ◽

Persons Who Use Drugs

Abstract Background Injection drug use is associated with serious infections. Due to challenges with medical management of addiction, relapses and additional infections are common. Persons who use drugs (PWUD) are more likely to leave against medical advice before completing treatment, which could result in treatment failure. Prolonged intravenous (IV) antimicrobial therapy in PWUD may be complicated by concern for IV catheter misuse, sometimes requiring prolonged hospitalization. Ideal alternatives would provide the following: (1) high success rate; (2) reduced rate of medical complications; (3) improved safety profiles; and (4) improved cost-effectiveness. Long-acting lipoglycopeptides present such opportunity for treatment of serious Gram-positive infections. Methods We performed a system-wide, retrospective analysis of adults admitted to University of Colorado Health from September 2015 to June 2018 and treated with dalbavancin or oritavancin based on clinical judgment of their treating physicians. Results Fifty-six patients met inclusion criteria (17 PWUD vs 39 non-PWUD). The PWUD group were younger, healthier by Charlson comorbidity index, more likely insured by Medicaid, and admitted for conditions requiring longer treatment. Ten patients were lost to follow-up. Of the patients with follow-up, clinical failure was met in 1 PWUD patient (6%) and 6 non-PWUD patients (15%) (P = .413). The median hospital length-of-stay reduction was 20 days (interquartile range [IQR], 10–30 days) in PWUD vs 11 days (IQR, 9–14 days) in non-PWUD; P = .133. Estimated median savings were $40 455.08 (IQR, $20 900.00–$62 700.00) in PWUD vs $19 555.08 (IQR, $15 375.08–$23 735.08) in non-PWUD; P = .065. Conclusions Long-acting lipoglycopeptides may be equally effective as standard-of-care, present a safety advantage, and secure earlier discharge and significant cost-savings.

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Early Short-Course Corticosteroids in Hospitalized Patients With COVID-19

Clinical Infectious Diseases ◽

10.1093/cid/ciaa601 ◽

2020 ◽

Vol 71 (16) ◽

pp. 2114-2120 ◽

Cited By ~ 87

Author(s):

Raef Fadel ◽

Austin R Morrison ◽

Amit Vahia ◽

Zachary R Smith ◽

Zohra Chaudhry ◽

...

Keyword(s):

Composite Endpoint ◽

Standard Of Care ◽

Multivariate Regression Analysis ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Short Course ◽

Group 5 ◽

Median Hospital

Abstract Background There is no proven antiviral or immunomodulatory therapy for coronavirus disease 2019 (COVID-19). The disease progression associated with the proinflammatory host response prompted us to examine the role of early corticosteroid therapy in patients with moderate to severe COVID-19. Methods We conducted a single pretest, single posttest quasi-experiment in a multicenter health system in Michigan from 12 March to 27 March 2020. Adult patients with confirmed moderate to severe COVID were included. A protocol was implemented on 20 March 2020 using early, short-course, methylprednisolone 0.5 to 1 mg/kg/day divided in 2 intravenous doses for 3 days. Outcomes of standard of care (SOC) and early corticosteroid groups were evaluated, with a primary composite endpoint of escalation of care from ward to intensive care unit (ICU), new requirement for mechanical ventilation, and mortality. All patients had at least 14 days of follow-up. Results We analyzed 213 eligible subjects, 81 (38%) and 132 (62%) in SOC and early corticosteroid groups, respectively. The composite endpoint occurred at a significantly lower rate in the early corticosteroid group (34.9% vs 54.3%, P = .005). This treatment effect was observed within each individual component of the composite endpoint. Significant reduction in median hospital length of stay was also observed in the early corticosteroid group (5 vs 8 days, P < .001). Multivariate regression analysis demonstrated an independent reduction in the composite endpoint at 14-days controlling for other factors (adjusted odds ratio: 0.41; 95% confidence interval, .22 – .77). Conclusions An early short course of methylprednisolone in patients with moderate to severe COVID-19 reduced escalation of care and improved clinical outcomes. Clinical Trials Registration NCT04374071.

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44. Cost Effectiveness and Clinical Outcomes of Long Acting Lipoglycopeptides Used in Transitions of Care for Deep-Seated Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.246 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S143-S144

Author(s):

Kayla S Antosz ◽

Julie Ann Justo ◽

Majdi N Al-hasan ◽

Benjamin Tabor ◽

Joseph Kohn ◽

...

Keyword(s):

Cost Effectiveness ◽

Length Of Stay ◽

Panel Member ◽

Cost Of Care ◽

Socioeconomic Factor ◽

Clinical Failure ◽

Research Support ◽

Review Panel ◽

Long Acting ◽

Antibiotic Courses

Abstract Background Dalbavancin and oritavancin are long-acting lipoglycopeptides (LaLGPs) FDA-approved for one-time only dosing for skin and skin structure infections. The use of these agents in serious, deep-seated infections requiring protracted antibiotic courses is of increasing interest. The purpose of this study is to evaluate the economic and clinical utility of LaLGPs in patients requiring protracted antibiotic courses who are not ideal candidates for oral transition or outpatient parenteral antibiotic therapy (OPAT). Methods This is a retrospective, observational, matched cohort study of adult patients who received a LaLGP. Patients who received a LaLGP were matched 1:1 to those who received standard of care (SOC) therapy by age (+/- 10 years), infection type, microorganism, and socioeconomic factor (e.g. persons who inject drugs, homelessness). Cost effectiveness was evaluated as total healthcare-related costs between groups. Clinical failure was a composite endpoint of mortality, recurrence, or need for extended antibiotics beyond planned course within 90 days of initial infection. Secondary outcomes included hospital length of stay and proportion of patients who left against medical advice (AMA). Results A total of 46 patients were included (23 per group). The most frequent indication was endovascular infection and the most common organism methicillin-resistant Staphylococcus aureus. The average length of stay was 22.9 days vs. 31.9 days in the LaLGP and SOC cohorts, respectively (p=0.153). The average total healthcare-related cost of care was USD &295,589 in the LaLGP cohort compared to &326,089 in the SOC cohort (p=0.282). LaLGPs were associated with a mean savings of &30,500 - &55,831 per patient (cumulative cost savings of &701,510). There was no difference in clinical failure between the two cohorts (22% vs. 30%; p=0.491). Nearly 26% of patients in the SOC cohort left AMA compared to 0% in the LaLGP cohort (p=0.022). Conclusion Receipt of LaLGPs may be a beneficial treatment option for patients with socioeconomic factors and deep-seated infections who are not candidates for oral transition or OPAT. Disclosures Julie Ann Justo, PharmD, MS, BCPS-AQ ID, bioMerieux (Speaker’s Bureau)Merck & Co. (Advisor or Review Panel member)Therapeutic Research Center (Speaker’s Bureau)Vaxart (Shareholder) P. Brandon Bookstaver, Pharm D, ALK Abello, Inc. (Grant/Research Support, Advisor or Review Panel member)Biomerieux (Speaker’s Bureau)Kedrion Biopharma (Grant/Research Support, Advisor or Review Panel member)

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Laparoscopy in Liver Transplantation: The Future Has Arrived

HPB Surgery ◽

10.1155/2012/148387 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Quirino Lai ◽

Rafael S. Pinheiro ◽

Giovanni B. Levi Sandri ◽

Gabriele Spoletini ◽

Fabio Melandro ◽

...

Keyword(s):

Liver Transplantation ◽

Scientific Progress ◽

Laparoscopic Approach ◽

Standard Of Care ◽

Radical Change ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Therapeutic Laparoscopy ◽

Stage Disease ◽

End Stage

In the last two decades, laparoscopy has revolutionized the field of surgery. Many procedures previously performed with an open access are now routinely carried out with the laparoscopic approach. Several advantages are associated with laparoscopic surgery compared to open procedures: reduced pain due to smaller incisions and hemorrhaging, shorter hospital length of stay, and a lower incidence of wound infections. Liver transplantation (LT) brought a radical change in life expectancy of patients with hepatic end-stage disease. Today, LT represents the standard of care for more than fifty hepatic pathologies, with excellent results in terms of survival. Surely, with laparoscopy and LT being one of the most continuously evolving challenges in medicine, their recent combination has represented an astonishing scientific progress. The intent of the present paper is to underline the current role of diagnostic and therapeutic laparoscopy in patients waiting for LT, in the living donor LT and in LT recipients.

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Impact of remote biometric monitoring on cost and hospitalization outcomes in peritoneal dialysis

Journal of Telemedicine and Telecare ◽

10.1177/1357633x18784417 ◽

2018 ◽

Vol 25 (10) ◽

pp. 581-586 ◽

Cited By ~ 11

Author(s):

Susie Q Lew ◽

Neal Sikka ◽

Clinton Thompson ◽

Manya Magnus

Keyword(s):

Blood Pressure ◽

Peritoneal Dialysis ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Hospital Length ◽

Cost Of Care ◽

Hospital Length Of Stay ◽

Inpatient Setting ◽

Post Intervention

IntroductionPeritoneal dialysis is a home-based therapy for individuals with end-stage renal disease. Telehealth, and in particular – remote monitoring, is making inroads in managing this cohort.MethodsWe examined whether daily remote biometric monitoring (RBM) of blood pressure and weight among peritoneal dialysis patients was associated with changes in hospitalization rate and hospital length of stay, as well as outpatient, inpatient and overall cost of care.ResultsOutpatient visit claim payment amounts (in US dollars derived from CMS data) decreased post-intervention relative to pre-intervention for those at age 18-54 years. For certain subgroups, non- or nearly-significant changes were found among female and Black participants. There was no change in inpatient costs post-intervention relative to pre-intervention for females and while the overall visit claim payment amounts increased in the outpatient setting slightly (US$511.41 (1990.30) vs. US$652.61 (2319.02), p = 0.0783) and decreased in the inpatient setting (US$10,835.30 (6488.66) vs. US$10,678.88 (15,308.17), p = 0.4588), these differences were not statistically significant. Overall cost was lower if RBM was used for assessment of blood pressure and/or weight (US$–734.51, p < 0.05). Use of RBM collected weight was associated with fewer hospitalizations (adjusted odds ratio 0.54, 95% confidence interval 0.33–0.89) and fewer days hospitalized (adjusted odds ratio 0.46, 95% confidence interval 0.26–0.81). Use of RBM collected blood pressure was associated with increased days of hospitalization and increased odds of hospitalization.ConclusionsRBM offers a powerful opportunity to provide care to those receiving home therapies such as peritoneal dialysis. RBM may be associated with reduction in both inpatient and outpatient costs for specific sub-groups receiving peritoneal dialysis.

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663 Application and Management of Cultured Epithelial Autografts (CEAs) on Posterior Burns – A 5-year, Multi-center, Retrospective Review of Outcomes

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.309 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S187-S187

Author(s):

Bounthavy Homsombath ◽

Zaheed Hassan ◽

Shawn P Fagan ◽

Beretta C Coffman

Keyword(s):

Graft Loss ◽

Hospital Length ◽

Cost Of Care ◽

Hospital Length Of Stay ◽

Anatomical Location ◽

Number Of Patients ◽

Posterior Trunk ◽

Specific Care ◽

Cultured Epithelial Autografts ◽

Wound Bed Preparation

Abstract Introduction In patients with larger burns, treatment with CEAs have proven to increase survival.1 CEAs, while useful, are not without some disadvantages. For instance, if the injury involves burns to posterior surfaces, the challenge is inherent in that these fragile sheets are easily sheared, and pressure can cause disruption and graft loss. CEA grafting must be managed with specific care and with specialized protocols that help address these challenges. Graft loss due to these and other factors can delay healing, increase hospital length of stay, and increase the cost of care. The purpose of this study is to evaluate the success for graft take in patients with posterior burns treated with CEA and to discuss the techniques, protocols and approaches to managing these patients within our burn network. Methods This retrospective study was granted exemption by IntegReview IRB. Take rate for each application of CEA was not always found for some cases. For purposes of this study, we agreed with methods of other researchers in the literature and adapted the “clinically relevant” assessment that take and final coverage was successful when re-grafting was not required by the time of discharge or death.2 Results Study dates was March 2016 - December 2019 and at this time, is being reported from among 3 of 6 participating centers. Our approach is to provide CEA prep the day before initial placement and then to ensure strict protocols are followed at the bedside post-op and thereafter. Total number of patients considered was 68, 41 were deemed evaluable. See tables for other demographics and results. 31 patients were discharged to rehab (75%), 6 were discharged home (15%) and 4 died (10%). Conclusions Meticulous attention to wound bed preparation and ensuring that post-op care is clearly stated and understood by all clinicians involved in the care of patients with larger burns with posterior trunk involvement is the key to successful coverage with CEA to this challenging anatomical location.

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Trauma Attending Physician Continuity: Does it Make a Difference?

The American Surgeon ◽

10.1177/000313481007600110 ◽

2010 ◽

Vol 76 (1) ◽

pp. 48-54

Author(s):

David G. Jacobs ◽

Jennifer L. Sarafin ◽

Karen E. Head ◽

A Britt Christmas ◽

Toan Huynh ◽

...

Keyword(s):

Length Of Stay ◽

Injury Severity ◽

Standard Of Care ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Trauma Service ◽

Retrospective Comparison ◽

Scale Scores ◽

Attending Physician

Continuity of care is important in achieving optimal outcomes in trauma patients, but the optimal length of the trauma attending (TA) rotation is unknown. We hypothesize that longer TA rotations provide greater continuity, and therefore improve outcomes. We did a retrospective comparison of trauma patient outcomes from two consecutive 6-month periods during which we transitioned from a 1-month TA rotation to a 1-week TA rotation. The Wilcoxon rank sum test, and the χ2 were used for statistical analysis. Over the 12-month study period 1924 patients were admitted to the Trauma Service. The two groups were similar with regard to age, gender, injury mechanism, Injury Severity Score and Glasgow Coma Scale scores, and Abbreviated Injury Scores for the chest, abdomen, and extremities. Although mortality, patient charges, and violations of the standard of care were similar between the two groups, overall morbidity was lower (18.6% vs 23.2%), and hospital length of stay higher (9.07 days vs 8.41 days) in the 1-week TA group compared with the 1-month TA group. A one-week TA rotation was associated with a longer hospital length of stay, but improved morbidity. Longer TA rotations do not necessarily provide improved continuity or improved outcomes.

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Optimal use of tocilizumab for severe and critical COVID-19: a systematic review and meta-analysis

F1000Research ◽

10.12688/f1000research.45046.1 ◽

2021 ◽

Vol 10 ◽

pp. 73

Author(s):

Cahyo Wibisono Nugroho ◽

Satriyo Dwi Suryantoro ◽

Yuliasih Yuliasih ◽

Alfian Nur Rosyid ◽

Tri Pudy Asmarawati ◽

...

Keyword(s):

Systematic Review ◽

Length Of Stay ◽

Critically Ill ◽

Meta Analysis ◽

Standard Of Care ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Eligibility Criteria ◽

All Cause Mortality ◽

Clinical Benefits

Background: Several studies have revealed the potential use of tocilizumab in treating COVID-19 since no therapy has yet been approved for COVID-19 pneumonia. Tocilizumab may provide clinical benefits for cytokine release syndrome in COVID-19 patients. Methods: We searched for relevant studies in PubMed, Embase, Medline, and Cochrane published from March to October 2020 to evaluate optimal use and baseline criteria for administration of tocilizumab in severe and critically ill COVID-19 patients. Research involving patients with confirmed SARS-CoV-2 infection, treated with tocilizumab and compared with the standard of care (SOC) was included in this study. We conducted a systematic review to find data about the risks and benefits of tocilizumab and outcomes from different baseline criteria for administration of tocilizumab as a treatment for severe and critically ill COVID-19 patients. Results: A total of 26 studies, consisting of 23 retrospective studies, one prospective study, and two randomised controlled trials with 2112 patients enrolled in the tocilizumab group and 6160 patients in the SOC group, were included in this meta-analysis. Compared to the SOC, tocilizumab showed benefits for all-cause mortality events and a shorter time until death after first intervention but showed no difference in hospital length of stay. Upon subgroup analysis, tocilizumab showed fewer all-cause mortality events when CRP level ≥100 mg/L, P/F ratio 200-300 mmHg, and P/F ratio <200 mmHg. However, tocilizumab showed a longer length of stay when CRP <100 mg/L than the SOC. Conclusion: This meta-analysis demonstrated that tocilizumab has a positive effect on all-cause mortality. It should be cautiously administrated for optimal results and tailored to the patient's eligibility criteria.

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The Use of Convalescent Plasma (CP) Transfusion Therapy in Moderate to Severe COVID-19 Patients: a Single Center Experience in Indonesia

Biomedical & Pharmacology Journal ◽

10.13005/bpj/2334 ◽

2021 ◽

Vol 14 (4) ◽

pp. 2327-2335

Author(s):

Adiatmo Pratomo ◽

Nina Mariana ◽

Surya Otto Wijaya ◽

Betha Ariesanty ◽

Titi Sundari ◽

...

Keyword(s):

Antiviral Agent ◽

Standard Of Care ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Single Institution ◽

Transfusion Therapy ◽

Single Center Experience ◽

Disease Hospital ◽

Age Range ◽

Further Development

Background: Coronavirus disease 2019 (COVID-19) was declared as a world pandemic since early 2020. There was no specific antiviral agent that appeared to be active against the virus, and antiviral agent such as remdesivir, favipiravir were in limited supply. We evaluated the use of convalescent plasma (CP) administered as adjuctive treatment to standard of care in moderate to severe COVID-19 patients. Methods: We conducted a series of 9 moderate to severe patients of COVID-19 older than 18 years received CP transfusion from 9 recovered donors at a single institution (Sulianti Saroso Infectious Disease Hospital, Jakarta, Indonesia) from January 2021 to June 2021. Results: Out of 9 patients (age range 30-81 years, 6 males and 3 female), and all patients received at least 1 or 2 unit of 200 mL of CP from 9 recovered donors. There were 4 patients (age range 30-71 years, 4 male) that were not treated with antiviral therapy. Of the 9 patients, 2 severe cases were died, while all of moderate cases survived and they were discharged from the hospital (length of stay: 8-22 days). Conclusion: Our experience showed that CP transfusion in moderate COVID-19 patients might provide clinical benefit and it was well-tolerated. However, further development clinical trials with better designs and greater power is needed to evaluate the efficacy and safety of this treatment.

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2286. Evaluating the Impact of Ceftolozane/Tazobactam on Clinical Outcomes in Patients with Multi-Drug-resistant Pseudomonas aeruginosa Pneumonia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1964 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S783-S784

Author(s):

Matthew Mills ◽

Ashley MacWhinnie ◽

Timmy Do

Keyword(s):

Pseudomonas Aeruginosa ◽

Length Of Stay ◽

Clinical Cure ◽

Standard Of Care ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Multi Drug Resistance ◽

Average Hospital ◽

Definitive Therapy ◽

The Impact

Abstract Background Ceftolozane/tazobactam is a novel cephalosporin and β-lactamase inhibitor antibiotic that has shown to have potent activity against Pseudomonas aeruginosa including strains exhibiting multi-drug resistance (MDR). The purpose of this study was to evaluate ceftolozane/tazobactam efficacy in MDR P. aeruginosa pneumonia compared with historical standard of care. Methods This was a retrospective cohort study of patients hospitalized across AdventHealth Central Florida campuses with MDR P. aeruginosa pneumonia from January 1, 2017 through December 31, 2018. This study included patients ≥ 18 years of age with a diagnosis of pneumonia and a positive respiratory culture with MDR P. aeruginosa. The primary outcome of this study was the rate of clinical cure by day 14 of definitive therapy. Secondary outcomes included 30-day readmission rate, average hospital length of stay (LOS), cost of admission, average ICU LOS after initiation of definitive antibiotic, and total days of antibiotic exposure for pneumonia. Data were analyzed with statistical computer software utilizing independent samples t-test and chi square tests of independence as appropriate. Results A total of 115 patients were included in the final analysis, 62 patients treated with ceftolozane/tazobactam and 53 patients treated with historical standard of care. Rate of clinical cure was similar between patients treated with ceftolozane/tazobactam, 72.6% (n = 45), and those treated with historical standard of care, 67.9% (n = 36), {X2 (1) = 0.297, p = 0.683}. Other outcomes assessed were also similar between groups except for average hospital length of stay (42.7 days vs. 30.3 days t(113) = 2.054, p = 0.042), and cost of admission ($78,550 vs. $47,681, t(113) = 2.458, p = 0.016), which were significantly greater in the ceftolozane/tazobactam treatment group. Conclusion In patients diagnosed with MDR P. aeruginosa pneumonia, clinical cure rates were not significantly different between those treated with ceftolozane/tazobactam compared with historical standard of care. Significantly greater hospital length of stay and cost of admission was associated with use of ceftolozane/tazobactam, although many patient factors may have influenced these results. Disclosures All authors: No reported disclosures.

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