0
Chest Infections |

Retrospective Assessment of Time to Being Dischargeable From Hospital for Community Acquired Pneumonia (CAP) Using Data From the FOCUS Trials

Thomas Lodise, PharmD; A. Anzueto, MD; Andrew Shorr, MD; David Weber, MD; Min Yang, PhD; Alexander Smith, MS; Qi Zhao, MPH; Xingyue Huang, PhD; Thomas File, MD
Author and Funding Information

Albany College of Pharmacy and Health Sciences, Albany, NY


Chest. 2013;144(4_MeetingAbstracts):267A. doi:10.1378/chest.1705024
Text Size: A A A
Published online

Abstract

SESSION TITLE: Respiratory Infections Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: The study objective was to better quantify time to “readiness-to-discharge” among patients with CAP who received ceftaroline or ceftriaxone in the FOCUS trials. While hospital length of stay (LOS) comparisons are difficult to make from Phase III CAP trials, an opportunity still exists to draw inferences about potential LOS differences between treatments through the use of surrogates for hospital discharge. Criteria for a “dischargeable” patient with CAP are well described in the literature and consistent with the definition of clinical response at 72-96 hours used by the FDA for CAP.

METHODS: Data were obtained from the FOCUS clinical trials (NCT00621504 and NCT00509106). Based on the Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS) CAP management guidelines, a post-hoc adjudication algorithm was developed to determine time to being dischargeable, time to inpatient clinical stability, and time to inpatient symptom improvement. Kaplan-Meier analyses were conducted for each endpoint and patients were censored at Day 7 as failure if not meeting the criteria. Sensitivity analyses were conducted, varying the dischargeable criteria, including respiratory rate, mental health status, and number of symptoms improvement. Cox proportional-hazards models were conducted to adjust for potential confounding covariates.

RESULTS: Analysis included 1,116 patients (ceftaroline n=562; ceftriaxone n=554) with evaluable data for the IDSA/ATS dischargeable criteria. Treatments groups were similar at baseline, except more patients treated with ceftaroline had a prior diagnosis of pneumonia. Kaplan-Meier analyses showed that ceftaroline was associated with a shorter time, measured in days, to meeting discharge and clinical stability criteria (p=0.034 and p=0.019, respectively); consistent results were observed in sensitivity analyses. In the Cox regression, ceftaroline was associated with a shorter time to being dischargeable (HR: 1.16, p=0.022) and achieving clinical stability (HR: 1.18, p=0.010). No statistical significant difference was observed for time to inpatient symptom improvement.

CONCLUSIONS: Relative to ceftriaxone, use of ceftaroline may be associated with earlier time to hospital discharge and to being clinically stable among hospitalized CAP patients.

CLINICAL IMPLICATIONS: Retrospective evaluation is a valid approach for assessing “readiness-to-discharge” in CAP patients.

DISCLOSURE: Thomas Lodise: Consultant fee, speaker bureau, advisory committee, etc.: received consulting fees from Forest Laboratory, Inc. A. Anzueto: Consultant fee, speaker bureau, advisory committee, etc.: received consulting fees from Forest Laboratory, Inc. Andrew Shorr: Consultant fee, speaker bureau, advisory committee, etc.: received consulting fees from Forest Laboratory, Inc. David Weber: Fiduciary position (of any organization, association, society, etc, other than ACCP: received consulting fees from Forest Laboratory, Inc. Min Yang: Consultant fee, speaker bureau, advisory committee, etc.: employee of Analysis Group, inc., which provides consulting services to Forest Laboratory, Inc. for this study Alexander Smith: Employee: Employee of Cerexa, Inc., which is a wholly-owned subsidiary of Forest Laboratories Qi Zhao: Employee: Employee of Forest Research Institute, Forest Laboratories' scientific subsidiary Xingyue Huang: Employee: Employee of Forest Research Institute, Forest Laboratories' scientific subsidiary Thomas File: Consultant fee, speaker bureau, advisory committee, etc.: received consulting fees from Forest Laboratory, Inc.

No Product/Research Disclosure Information


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543