Hospital charges included all billing (e.g., procedures, diagnostic tests, medications, facility fees) during the patients admission and does not reflect any discounts, insurance payments, billing reductions, or actual patient payments. Secondary outcomes included ICU DMH-1 or hospital length of stay, initiation of noninvasive or invasive ventilation after hospital day 2, tracheostomy, 30-day readmission for a primary diagnosis of AECOPD, and time to next readmission with a primary diagnosis of AECOPD. groups. Propensity score analysis successfully matched 8,660 patients in each treatment group. Measurements and Main Results: In the matched cohort, the macrolide treatment group was not associated with decreased hospital mortality after day 2 (3.0% vs 3.3%, p=0.28), intensive care unit length of stay (2 days vs 2 days, p=0.12), hospital length of stay (6 days vs 6 days, p=0.86), or length of assisted ventilation (3 days vs 3 days, p=0.71), compared with the non-macrolide treatment group. However, a macrolide-based antibiotic regimen was associated with an overall reduction in 30-day hospital readmissions (7.3% vs 8.8%, p 0.01), increased time Mouse monoclonal to NFKB1 to next all-cause (159 vs 130 days, p 0.01) or AECOPD (200 vs 175 days, p=0.03) readmission, and decreased hospital costs ($32,730 vs $34,021, p 0.01). Conclusion: The results of this study suggest that inclusion of a macrolide antibiotic in the treatment regimen may have both acute and sustained benefits in critically DMH-1 ill patients admitted to the intensive care unit with an AECOPD, including reductions in hospital readmissions and improvements in time to next readmission. species are present.2, 12 The optimal antibiotic regimen for AECOPD has not been established; however, commonly used antibiotics include -lactams (e.g. amino-penicillin with clavulanic acid or a third-generation cephalosporin), fluoroquinolones, tetracyclines, or macrolides.2, 12 Macrolide antibiotics are unique in that they have both antimicrobial activity and broad immunomodulatory effects that may be beneficial for AECOPD.13C16 These properties have led to the success of chronic macrolide therapy in the prevention of COPD exacerbations.17, 18 In addition, use of macrolides for non-ICU, AECOPD hospitalizations have been associated with a number of clinical benefits compared with fluoroquinolones.19, 20 However, to our knowledge, no studies have compared the efficacy of macrolide DMH-1 antibiotic therapy with other antibiotic classes in the treatment of critically ill patients with AECOPD. To address this question, we conducted a large, multicenter comparative-effectiveness study to evaluate macrolide versus non-macrolide antibiotic therapy in critically ill patients with AECOPD and hypothesized that macrolide antibiotics may be associated with decreased mortality, hospital readmissions, or other clinically important outcomes, and reduced hospital cost. Methods Study Design and Data Source A pharmacoepidemiologic cohort study was designed to evaluate patient data voluntarily submitted to the Premier Perspective Hospital Database (Premier, Inc., Charlotte, NC). The Premier database currently includes over 970 United StatesCbased hospitals representing approximately 25% of annual U.S. inpatient admissions.21 This database contains patient characteristics, therapies, disease state classifications according to the (ICD-9), and clinical outcomes.21 The Colorado Multiple Institutional Review Board provided approval for the conduct of this study. Patient Population Patients were included in this study if they were aged 40 years or older; were admitted to an intensive care unit between January 1, 2010, and December 31, 2014, due to a principal admitting analysis of AECOPD (ICD-9 code 491.21); and received either macrolide or non-macrolide antibiotic treatment within the 1st 48 hours of their admission. To narrow the patient population to a primary focus on AECOPD and to evaluate the impact of the 1st course of inpatient antibiotics on results, individuals were excluded if any of the following conditions were present: transfer from outside hospital; hospital stay of 2 days or less; admission analysis of pulmonary embolism, pneumothorax, or pneumonia; receipt of intravenous vasopressors on hospital day time 1 or 2 2; solid organ transplantation; receipt of greater than 1 g/day time of methylprednisolone or comparative; or data necessary for analysis were incomplete or missing. Outcomes We compared associations between individuals treated with macrolide- and nonCmacrolide-based antibiotic regimens and the primary results of in-hospital mortality, all-cause readmission within 30 days, time to all-cause readmission, and hospital charges. Hospital costs included all billing (e.g., methods, diagnostic tests, medications, facility charges) during the individuals admission and does not reflect.
