• Jonnie Albertsen posted an update 1 year, 6 months ago

    This is higher than the 4–6% of patients with sepsis in trials of antibiotic treatment of cSSTI with or without microbiological evidence of MRSA [21] and [25]. In addition, patients in this real-world study were older and had more baseline co-morbidities compared with typical clinical trial populations [26]. Although we were unable to assess extent and severity using lesion size in this retrospective study, as is done in a clinical trial, the current population were all MRSA-confirmed cSSTI, which is considered a more severe population than more recent trials assessing the broader indication of acute bacterial skin and skin-structure infections with only MRSA subpopulations present [26]. One strength of this data set is that it was collected in a consistent manner across countries, which makes it possible to evaluate differences throughout Europe. However, we accept that the case-mix in the different hospital populations was not uniform and may make benchmarking difficult. This study fills a gap in the literature by providing practice pattern data for each country included together with patient clinical and demographic characteristics. In addition, differences in living conditions, infrastructure of outpatient treatment, usual treatment behaviours and culture, and healthcare system economics may also contribute to the observed differences across countries. Incentives and barriers for discharge and reimbursement are likely significant drivers for the differences observed. In comparison with the typical real-world US LoS for cSSTI of ca. 5 days [27] where there are strong incentives to minimise hospital days, the typical LoS in this observational European study was ca. 20 days in an MRSA-specific population. These differences in LoS by region have also been confirmed in a phase 4 MRSA cSSTI clinical trial [13], with the USA having a LoS of ca. 4–5 days while Europe had a LoS of ca. 13–15 days. The long LoS in the current study may have resulted in the low 30-day post-discharge recurrence (<1%) and re-admission (<1%) rates due to MRSA cSSTI, coupled with the potential limitation in follow-up data availability if patients were re-admitted to a different hospital. In the USA, 30-day re-admission rates for cSSTI are significant at 7–13% for cSSTI in retrospective observational analyses [28]. Limitations of this study include the Antiinfection Compound Library supplier retrospective observational design in the calculation of potential country cost savings with application to ES and ED criteria. To verify the findings, a prospective trial should test the effect of implementing defined ES and ED criteria, or a controlled cohort study could compare the same hospitals before and after the implementation of such criteria. However, such studies may not be practical or economical given the complexities of such a multinational study.