Introduction: Severe infections require early optimization of antibiotic therapy. Since 2016, antibiotic susceptibility results with minimum inhibitory concentrations (MIC) direct from positive blood cultures are available in less than 8 h using a new diagnostic system. The aim of this study is to investigate the economic effects of a rapid availability of antibiotic susceptibility in Germany and to validate these theoretical results in a German hospital.
Materials and methods: In the context of a literature search, the clinical and economic benefit of an adequate therapy as well as the rate of the initially inadequate antibiotic therapy (IIAT) were determined for sepsis and bloodstream infections. In addition to the weighted average of the pooled studies, the case numbers in Germany (data year 2015) of all DRGs for sepsis patients with coded pathogen and ICU stay were integrated into a theoretical economic model that was subsequently validated in a German hospital.
Results: The analysis of 14 studies with a total of 6408 patients showed an average weighted rate of 27.3% IIAT. From a total of 8 studies (n = 2988), an average weighted length of stay (LOS) saving of 4.7 days was determined with adequate initial therapy compared to an IIAT. In the theoretical model, an average of € 1539 per case could be saved with a possible LOS reduction of 3.7 days. A conservative scenario with an IIAT of 20% and LOS reduction of 2.5 days still resulted in an average saving of € 201 per case. In the hospital-individual model, 68% of 146 cases had a positive blood culture. In 61% of the examined cases an adjustment of the therapy would have been necessary (35% IIAT, 26% de-escalation). After deducting the cost of the test for 60 patients, the total potential savings amounted to € 122,112, which is over 2000 € per patient.
Conclusion: A fast adequate antibiotic therapy was economically advantageous both in the economic model and in the real-life evaluation. The optimization of antibiotic therapy by early pathogen detection and MIC-based susceptibilities represents a possibility to achieve savings despite the high costs for diagnostics in the clinic. Particularly noteworthy is the optimization through de-escalation. The potential for each hospital should be identified through systematic case studies.
Keywords: Economic savings; Initial inadequate antibiotic therapy (IIAT); Minimum inhibitory concentration; Pathogen identification; Sepsis.