97 A review of inpatient antibiotic prescribing after 7 years – scratching below the surface

Abstract

Introduction Admission to hospital is costly, increases risk of cross infection and may have psychological and financial consequences for patients. To circumvent this, we developed a policy of actively managing patients in the community when they are ill. We have looked at whether this reduced inpatient burden in our large adult CF clinic. Method We compared admissions for IV antibiotic therapy in 2006/07 with 2013/14, looking at patients' clinical characteristics and inpatient stay. Results The proportion of patients admitted fell from 54% in 2006/7 (119/222) to 48% in 2013/4 (135/281), although there was no difference in number of admissions (285, 1.3 per patient vs 308 and 1.1 respectively; χ 2 = 1.68, P=NS). However, total number of inpatient antibiotic days and average duration of stay was less in the 2013/14 group (3875 days vs 4033 in 2006/07, p ≤ 0.001; and 12.6 vs 14.1 respectively, p=0.003). Patients admitted had similar FEV1 (2006/07 mean 68% vs 66%, p=NS), but those admitted in 2013/14 were older (mean 29 yrs vs 2006/07 25 yrs, p=0.0008). In relation to infection, only those with B. cepacia had a reduction in bed days (mean 9.9 vs 15.1 days in 2006/07, p=0.001) and those with Liverpool Epidemic Strain P. aeruginosa were older (mean 29 yrs vs 24 in 2006/07, p Conclusion This study demonstrates that although the number of patients admitted remained unchanged, we are admitting them less frequently and for a shorter duration. This may be due to more effective use of home IV therapy. In addition, patients admitted are tending to be older and this may be related to better availability of nebulised antibiotic therapies resulting in slower disease progression.