Influence of real-world characteristics on outcomes for patients with methicillin-resistant Staphylococcal skin and soft tissue infections:a multi-country medical chart review in Europe

BACKGROUND: Patient-related (demographic/disease) and treatment-related (drug/clinician/hospital) characteristics were evaluated as potential predictors of healthcare resource use and opportunities for early switch (ES) from intravenous (IV)-to-oral methicillin-resistant Staphylococcus aureus (MRSA)-active antibiotic therapy and early hospital discharge (ED). METHODS: This retrospective observational medical chart study analyzed patients (across 12 European countries) with microbiologically confirmed MRSA complicated skin and soft tissue infections (cSSTI), ≥3 days of IV anti-MRSA antibiotics during hospitalization (July 1, 2010-June 30, 2011), and discharged alive by July 31, 2011. Logistic/linear regression models evaluated characteristics potentially associated with actual resource use (length of IV therapy, length of hospital stay [LOS], IV-to-oral antibiotic switch), and ES and ED (using literature-based and expert-verified criteria) outcomes. RESULTS: 1542 patients (mean ± SD age 60.8 ± 16.5 years; 61.5% males) were assessed with 81.0% hospitalized for MRSA cSSTI as the primary reason. Several patient demographic, infection, complication, treatment, and hospital characteristics were predictive of length of IV therapy, LOS, IV-to-oral antibiotic switch, or ES and ED opportunities. Outcomes and ES and ED opportunities varied across countries. Length of IV therapy and LOS (r = 0.66, p < 0.0001) and eligibilities for ES and ED (r = 0.44, p < 0.0001) showed relatively strong correlations. IV-to-oral antibiotic switch patients had significantly shorter length of IV therapy (−5.19 days, p < 0.001) and non-significantly shorter LOS (−1.86 days, p > 0.05). Certain patient and treatment characteristics were associated with increased odds of ES (healthcare-associated/ hospital-acquired infection) and ED (patient living arrangements, healthcare-associated/ hospital-acquired infection, initiating MRSA-active treatment 1–2 days post cSSTI index date, existing ED protocol), while other factors decreased the odds of ES (no documented MRSA culture, ≥4 days from admission to cSSTI index date, IV-to-oral switch, IV line infection) and ED (dementia, no documented MRSA culture, initiating MRSA-active treatment ≥3 days post cSSTI index date, existing ES protocol). CONCLUSIONS: Practice patterns and opportunity for further ES and ED were affected by several infection, treatment, hospital, and geographical characteristics, which should be considered in identifying ES and ED opportunities and designing interventions for MRSA cSSTI to reduce IV days and LOS while maintaining the quality of care. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/1471-2334-14-476) contains supplementary material, which is available to authorized users

Comparing five equations to estimate glomerular filtration rate or creatinine clearance and assign individuals to KDIGO categories across the full age spectrum using real world data

Abstract Five equations are commonly used by biopharma companies to estimate glomerular filtration rate (GFR) or creatinine clearance (CrCl) based on regulatory and stakeholder recommendations. Changes observed in GFR and/or CrCl can be challenging to interpret as participants transition between age strata, prompting changes in equations. This manuscript explores how GFR, CrCl, and the resulting Kidney Disease Improving Global Outcomes (KDIGO) categories of kidney function can change when different equations are used. We analyzed descriptively real‐world data (RWD) from 48 health care organizations in the United States to identify patients with data (age, sex, height, weight, serum biomarkers such as creatinine [Scr] and/or cystatin C [Scys]) sufficient to estimate GFR and/or CrCl. Five equations (Bedside Schwartz, Modified Schwartz, Cockcroft‐Gault, 2021 Chronic Kidney Disease‐Epidemiology Collaboration [CKD‐EPI] Scr, and 2021 CKD‐EPI Scr/Scys) were used to estimate GFR and/or CrCl and assign individuals to KDIGO categories (G1–G5). We identified 32,728 patients, including 378 infants (<2 years), 1191 younger children (2 to <6 years), 1891 older children (6 to <12 years), 3174 adolescents (12 to <18 years), 16,367 younger adults (18 to <65 years), and 9727 older adults (65+ years) with sufficient information to estimate kidney function. For patients greater than or equal to 2 years, estimated GFR and/or CrCl and KDIGO categories based on the 2021 CKD‐EPI Scr/Scys equation appeared similar to those based on currently recommended equations. RWD suggests the 2021 CKD‐EPI Scr/Scys equation could potentially be used to estimate GFR in individuals aged 2 years and older; more research is needed to confirm these findings