Community-acquired pneumonia:: influence of the duration of intravenous antibiotic therapy on hospital stay and the cost-benefit ratio

Intravenous antibiotic therapy (IVAT) is usually prescribed for patients hospitalized with community-acquired pneumonia (CAP). Studies have associated prolonged IVAT with longer hospital stays and higher costs. The aim of this study was to determine the factors that influence the expense generated by and mean stay of patients hospitalized for pneumonia, with special attention to the influence of IVAT duration. MATERIAL AND METHODS: One hundred twenty-five CAP patients admitted to the respiratory medicine wards of our hospital were randomly assigned to five different staff physicians. IVAT was prescribed following the norms of the Spanish Society of Respiratory Medicine and Chest Surgery (SEPAR). IVAT was withdrawn when the attending physician considered it appropriate. We collected epidemiological, comorbidity, clinical and analytical data. Complications were recorded and severity of CAP was classified using the model proposed by Fine. Follow-up care was given at an outpatient clinic until symptoms disappeared and chest films resolved. Multivariate analysis determined the factors predicting mean hospital stay and high cost. Costs were calculated based on data issued by the billing department. RESULTS: The mean cost of care was 307,274 pesetas, mean duration of IVAT was 5.8 days and mean hospital stay was 9.4 days. Multivariate analysis showed that cost was related to mean hospital stay and IVAT. Mean hospital stay was associated with IVAT, the presence of respiratory insuficiency and the day of the week when admission took place (with weekend admission leading to longer stays). CONCLUSIONS: The duration of IVAT in CAP influences mean hospital stay and cost, without adding any evident therapeutic benefit (in the group of patients selected). Recommendations for diagnosing and treating CAP may be advisable.