Abstract
BackgroundPatients prescribed intravenous (IV) glycopeptides usually remain in hospital until completion of this treatment. Some of these patients could be discharged earlier if a switch to an oral antibiotic was made. This study was designed to identify the percentage of inpatients currently prescribed IV glycopeptides who could be discharged earlier if a switch to an oral agent was used, and to estimate the number of bed days that could be saved. We also aimed to identify the patient group(s) most likely to benefit, and to estimate the number of days of IV therapy that could be prevented in patients who remained in hospital.MethodsPatients were included if they were prescribed an IV glycopeptide for 5 days or more. Predetermined IV to oral antibiotic switch criteria and discharge criteria were applied. A multiple logistic regression model was used to identify the characteristics of the patients most likely to be suitable for earlier discharge.ResultsOf 211 patients, 62 (29%) could have had a reduced length of stay if they were treated with a suitable oral antibiotic. This would have saved a total of 649 inpatient days (median 5 per patient; range 1–54). A further 31 patients (15%) could have switched to oral therapy as an inpatient thus avoiding IV line use. The patients most likely to be suitable for early discharge were those with skin and soft tissue infection, under the cardiology, cardiothoracic surgery, orthopaedics, general medical, plastic surgery and vascular specialities, with no high risk comorbidity and less than five other regularly prescribed drugs.ConclusionThe need for glycopeptide therapy has a significant impact on length of stay. Effective targeting of oral antimicrobials could reduce the need for IV access, allow outpatient treatment and thus reduce the length of stay in patients with infections caused by antibiotic resistant gram-positive bacteria.
Highlights
Patients prescribed intravenous (IV) glycopeptides usually remain in hospital until completion of this treatment
Many infections caused by methicillin sensitive S. aureus can be treated effectively with oral antibiotics, or a few days of IV antibiotics followed by oral therapy for the remainder of the course
In accordance with the trust's antibiotic guidelines, vancomycin was used as the first line glycopeptide
Summary
Patients prescribed intravenous (IV) glycopeptides usually remain in hospital until completion of this treatment. Some of these patients could be discharged earlier if a switch to an oral antibiotic was made. One consequence of the increase in antimicrobial resistance among gram-positive bacteria is an increase in the use of glycopeptides. These generally require intravenous (IV) administration, resulting in an increase in the use of IV lines. This in turn results in reduced mobility, and increased risk of line-related infections. Where a suitable oral agent exists, IV to oral switch programmes have been shown to be highly effective [11,12,13]
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