VARIATIONS IN ANTIMICROBIAL USE AND COST IN MORE THAN 2,000 PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA

PURPOSE: To assess the patterns of antimicrobial use, costs of antimic robial therapy, and medical outcomes by institution in patients with c ommunity-acquired pneumonia. PATIENTS AND METHODS: The route, dose, an d frequency of administration of all antimicrobial agents prescribed w ithin 30 days of presentation were recorded for 927 outpatients and 13 28 inpatients enrolled in the Pneumonia Patient Outcomes Research Team (PORT) multicenter, prospective cohort study. Total antimicrobial cos ts were estimated by summing drug costs, using average wholesale price for oral agents and institutional acquisition prices for parenteral a gents, plus the costs associated with preparation and administration o f parenteral therapy. Thirty-day outcome measures were mortality, subs equent hospitalization for outpatients, and hospital readmission for i npatients. RESULTS: Significant variation (P <0.05) in prescribing pra ctices occurred for 17 of the 23 antimicrobial agents used in outpatie nts across 5 treatment sites, and for 18 of the 20 parenteral agents u sed in inpatients across 4 treatment sites. The median duration of ant imicrobial therapy for treatment site ranged from 11 to 13 days for ou tpatients (P = 0.01), and from 13 to 15 days for inpatients (P = 0.49) . The overall median cost of antimicrobial therapy was $12.90 for outp atients, and ranged from $10.80 to $58.90 among treatment sites (P <0. 0001). The overall median cost of antimicrobial therapy was $228.70 fo r inpatients, and ranged from $183.70 to $315.60 among sites (P <0.000 1). Mortality and hospital readmission for inpatients were not signifi cantly different across sites after adjusting for baseline differences in patient demographic characteristics, comorbidity, and illness seve rity. Although subsequent hospitalization for outpatients differed by site, the rate was lowest for the site with the lowest antimicrobial c osts. CONCLUSION: Variations in antimicrobial prescribing practices by treatment site exist for outpatients and inpatients with community-ac quired pneumonia. Although variation in antimicrobial prescribing prac tices across institutions results in significant differences in antimi crobial costs, patients treated at institutions with the lowest antimi crobial costs do not demonstrate worse medical outcomes. (C) 1998 by E xcerpta Medica, Inc.