Abstract
To compare prognoses and adverse events between bacteraemic patients in the emergency department (ED) who received an early antimicrobial IV-to-PO switch and those treated with late or no IV-to-PO switch, an 8-year multicentre cohort consisting of adults with community-onset bacteraemia was conducted. The clinical characteristics and outcomes were compared in matched cohorts by the closest propensity score calculated based on the independent determinants of 30-day mortality identified by the multivariate regression model. Of the 6664 hospitalised patients who received no or late IV-to-PO switch, 2410 were appropriately matched with 482 patients treated with early IV-to-PO switch and discharged from the ED. There were no significant differences between the two matched groups in their baseline characteristics, including the patient demographics, severity and types of comorbidities, severity and sources of bacteraemia, and the 15- and 30-day mortality rates. Notably, in addition to the shorter lengths of intravenous antimicrobial administration and hospital stay, less phlebitis and lower antimicrobial costs were observed in patients who received an early IV-to-PO switch. Similarity was observed in the clinical failure rates between the two groups. Furthermore, the inappropriate administration of empirical antibiotics and inadequate source control were identified as the only independent determinants of the post-switch 30-day crude mortality in patients who received an early IV-to-PO switch. In conclusion, for less critically ill adults with community-onset bacteraemia who received appropriate empirical antimicrobial therapy and adequate source control, an early IV-to-PO switch might be safe and cost-effective after a short course of intravenous antimicrobial therapy.
Highlights
Community-onset bacteraemia is a common disease with an annual incidence of 0.82% [1], and these systemic infections are associated with a high morbidity and mortality, incurring significant healthcare costs [2]
Numerous studies have reported that emergency department (ED) overcrowding is a problematic concern in many areas [16,17]; it threatens patient safety and public health because it is associated with delays in clinical diagnoses and appropriate management [18]
As bacteraemic patients respond clinically to empirical antibiotic therapy (EAT) and prompt management during the first 24 h after the sampling of blood cultures, physicians may be informed about the growth of blood cultures
Summary
Community-onset bacteraemia is a common disease with an annual incidence of 0.82% [1], and these systemic infections are associated with a high morbidity and mortality, incurring significant healthcare costs [2]. It is understandable that ED physicians want to address the question, “is the strategy of early IV-to-PO switch effective for bacteraemic patients in the ED?". If this strategy is safe and efficacious, it is likely that an early switch from IV therapy to oral antibiotics is suitable to increase the ED capacity and thereby reduce ED overcrowding. Focusing on adults in the ED with community-onset bacteraemia, we compared the therapeutic efficacy and safety of early IV-to-PO switch and conventional IV therapy in matched patients using propensity scoring (PS)
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