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Medical resource utilization among patients with ventilator-associated pneumonia: pooled analysis of randomized studies of doripenem versus comparators

机译：呼吸机相关性肺炎患者的医疗资源利用：多瑞培南与比较者的随机研究汇总分析

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IntroductionVentilator-associated pneumonia (VAP) is associated with increased medical resource utilization, but few randomized studies have been conducted to evaluate the effect of initial antibiotic therapy. To assess medical resource utilization in patients with VAP, we conducted a pooled analysis of two prospective, randomized, open-label, multicenter, phase III studies, which also showed that doripenem was clinically noninferior to comparators.MethodsWe assessed durations of mechanical ventilation, intensive care unit (ICU) stay, and hospitalization in patients with VAP who received at least 1 dose of doripenem or a comparator in the phase III studies. Comparators were piperacillin/tazobactam (study 1) and imipenem (study 2). We analyzed between-group differences in medical resource utilization endpoints by comparison of Kaplan-Meier curves with generalized Wilcoxon test and in microbiologic eradication rates by two-sided Fisher's exact test.Results625 patients with VAP were evaluated and received at least 1 dose of doripenem (n = 312) or a comparator (n = 313). Median durations of mechanical ventilation (7 versus 10 days; P = 0.008) and hospitalization (22 versus 26 days; P = 0.010) were shorter for doripenem than comparators; corresponding ICU stays were 12 and 13 days (P = 0.065). All-cause, overall mortality rates were similar (51/312 [16%] versus 47/313 [15%]; P = 0.648). MIC90 values against Pseudomonas aeruginosa for doripenem versus imipenem were 4 versus 16 μg/mL in study 2. P. aeruginosa was eradicated from 16/24 (67%) doripenem recipients and 10/24 (42%) comparator recipients (P = 0.147). In patients with P. aeruginosa at baseline, median durations of mechanical ventilation (7 versus 13 days; P = 0.031) and ICU stay (13 versus 21 days; P = 0.027) were shorter for doripenem; corresponding hospital stays were 24 and 35 days (P = 0.129).ConclusionsDoripenem was associated with lower medical resource utilization than comparators. Differences in antipseudomonal activity may have contributed to these findings.Trial registrationClinicalTrials.gov number NCT00211003 (study 1) and NCT00211016 (study 2).
机译：简介呼吸机相关性肺炎（VAP）与医疗资源利用增加有关，但很少进行随机研究来评估初始抗生素治疗的效果。为了评估VAP患者的医疗资源利用情况，我们对两项前瞻性，随机，开放标签，多中心，III期研究进行了汇总分析，这些研究还表明多瑞培南在临床上不逊于比较者。在III期研究中接受了至少1剂量多瑞培南或比较药物的VAP患者的住院时间和住院治疗。比较者为哌拉西林/他唑巴坦（研究1）和亚胺培南（研究2）。我们通过比较Kaplan-Meier曲线和广义Wilcoxon检验，并通过双面Fisher精确检验比较了微生物根除率，分析了医疗资源利用终点之间的组间差异。结果对625例VAP患者进行了评估，并接受了至少1剂多利培南（ n = 312）或比较器（n = 313）。多利培南的机械通气中位时间（7天比10天; P = 0.008）和住院时间（22天比26天; P = 0.010）比比较者短。相应的ICU停留时间为12天和13天（P = 0.065）。全因总死亡率相似（51/312 [16％]对47/313 [15％]; P = 0.648）。在研究2中，多立培南和亚胺培南对铜绿假单胞菌的MIC90值分别为4和16μg/ mL，相对于16/24（67％）多立培南接受者和10/24（42％）比较者接受者消除了铜绿假单胞菌（P = 0.147） 。在基线时，铜绿假单胞菌患者的机械通气时间（7天vs 13天; P = 0.031）和ICU停留时间（13天vs 21天; P = 0.027）较短。相应的住院天数分别为24天和35天（P = 0.129）。抗假性伪狂犬病活性的差异可能是造成这些发现的原因。试验注册ClinicalTrials.gov编号为NCT00211003（研究1）和NCT00211016（研究2）。

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