Pan-European early switch/early discharge opportunities exist for hospitalised patients with methicillin-resistant Staphylococcus aureus complicated skin and soft-tissue infections

The objective was to document pan-European real-world treatment patterns and healthcare resource use and estimate opportunities for early switch (ES) from intravenous (IV) to oral antibiotics and early discharge (ED) in hospitalised patients with methicillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft-tissue infections (cSSTI). This retrospective observational medical chart review study enrolled 342 physicians across 12 European countries who collected data from 1542 patients with documented MRSA cSSTI, hospitalised (July 2010-June 2011) and discharged alive (by July 2011). Data included clinical characteristics and outcomes, hospital length of stay (LOS), MRSA-targeted IV and oral antibiotic use and ES and ED eligibility using literature-based and expert-validated criteria. The most frequent initial MRSA-active therapies were vancomycin (50.2%), linezolid (15.1%), clindamycin (10.8%) and teicoplanin (10.4%). Patients discharged with MRSA-active antibiotics (n = 480) were most frequently prescribed linezolid (42.1%) and clindamycin (19.8%). IV therapy duration (9.3 ± 6.5 vs. 14.6 ± 9.9 days; p <0.001) and hospital LOS (19.1 ± 12.9 vs. 21.0 ± 18.2 days; p = 0.162) tended to be shorter for patients switched from IV-to-oral therapy compared with patients who received IV only. 33.6% met ES criteria and could have discontinued IV therapy 6.0 ± 5.5 days earlier, and 37.9% met ED criteria and could have been discharged 6.2 ± 8.2 days earlier. More than one-third of European patients hospitalised for MRSA cSSTI could be eligible for ES and ED opportunities, resulting in substantial reductions in IV days and bed-days with potential savings of €2000 per ED-eligible patient.