Inpatient Intravenous Antibiotic Research Articles

Exploring patients' perspectives: a mixed methods study on Outpatient Parenteral Antimicrobial Therapy (OPAT) experiences.

Outpatient Parenteral Antimicrobial Therapy (OPAT), an alternative to inpatient intravenous antibiotic therapy, has shown benefits in international studies such as increased patient satisfaction. Because OPAT has been used only sporadically in Germany so far, no structured results on patients' experiences and concerns regarding OPAT have yet been available. This study therefore aims to explore the experiences of OPAT patients in a pilot region in Germany. This is an observational study in a German pilot region, including a survey of 58 patients on their experiences with OPAT, and in-depth interviews with 12 patients (explanatory-sequential mixed-methods design). Patients reported that they were satisfied with OPAT. That a hospital discharge was possible and anti-infective therapy could be continued in the home environment was rated as being particularly positive. In the beginning, many patients in the interviews were unsure about being able to administer the antibiotic therapy at home on their own. However, healthcare providers (doctors and pharmacy service provider staff) were able to allay these concerns. Patients appreciated regular contact with care providers. There were suggestions for improvement, particularly concerning the organization of the weekly check-up appointments and the provision of information about OPAT. Patients were generally satisfied with OPAT. However, the treatment structures in Germany still need to be expanded to ensure comprehensive and high-quality OPAT care. NCT04002453, https://www. gov/ , (registration date: 2019-06-21).

A Comparison of Parenteral and Per-Oral Antibiotic Usage in Pyogenic Flexor Tenosynovitis: A Retrospective Study.

Introduction Pyogenic flexor tenosynovitis (PFT) is a common hand infection that can cause significant morbidity. Although treatment involves surgical debridement and inpatient intravenous (IV) antibiotics, there is a paucity of literature guiding antibiotic use. This study aims to determine if the use of postoperative outpatient oral antibiotics leads to poor outcomes compared to IV antibiotics given in an institutional setting. Methods A retrospective review of 110 patients treated post-operatively with either outpatient oral or inpatient IV antibiotics at our institution from 2016-2019 was performed. All patients underwent surgical debridement. Primary outcomes analyzed included readmission, repeat surgery, and amputation. Clinical parameters including age, diabetes, smoking, duration of symptoms, involvement of surrounding structures (felon, dorsal abscess, osteomyelitis, septic arthritis), culture growth, Michon classification, and duration of antibiotics were analyzed as possible risk factors for poor outcome. The level of evidence of this study isLevel 3Retrospective Cohort Study. Results Seventy-five patients were treated with outpatient oral antibiotics and 35 patients were treated with inpatient IV antibiotics. The oral antibiotics group received antibiotics for 13.1 +/- 9.9 days compared to 18.1 +/-10.4 days in the IV antibiotic group. Patients in the oral antibiotic group had a significantly shorter length of hospitalization at 0.6 +/-1.8 days compared to 3.6 +/-1.8 days in the IV antibiotic group. The readmission rate for the oral antibiotic group was 10.7% compared to 5.7% in the IV antibiotic group.This difference was not statistically significant except in patients who had involvement in surrounding structures. There was no significant difference in repeat surgeries or amputationsbetween the groups. Conclusions The use of outpatient oral antibiotics after surgical debridement for PFT does not significantly increase rates of readmission, repeat surgery, or amputation, except in cases with the involvement of surrounding structures. On subgroup analysis, anaerobic infection and diabetes were significantly associated with amputations. Post-operative oral antibiotics and immediate discharge may be considered for PFT after adequate surgical debridement with close outpatient follow-up in the absence of surrounding structure involvement and diabetes.

Partial outpatient oral antibiotic treatment of infective endocarditis is non-inferior to inpatient intravenous antibiotic therapy

A clinical decision report using: Iversen K, Ihlemann N, Gill SU, et al. Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis. N Engl J Med. 2019; 380:415-424. https://doi.org/10.1056/NEJMoa1808312 for a patient with infective endocarditis and intravenous drug use with desire to leave the hospital.

Take‐home antibiotics better than inpatient for endocarditis: NIDA

Instead of four to six weeks of inpatient intravenous antibiotics, patients who inject opioids and are treated for infective endocarditis should be given an antibiotic to take outside the hospital, according to a new modeling study funded by the National Institute on Drug Abuse (NIDA).

58. Cost-Effectiveness of Emerging Antibiotic Strategies for the Treatment of Drug-Use Associated Infective Endocarditis

BackgroundDrug use-associated infective endocarditis (DUA-IE) is typically treated with 4-6 weeks of in hospital intravenous antibiotics (IVA). Outpatient parenteral antimicrobial therapy (OPAT) and partial oral antibiotics (PO) may be as effective as IVA, though long-term outcomes and costs remain unknown. We evaluated the clinical outcomes and cost-effectiveness of four antibiotic treatment strategies for DUA-IE. MethodsWe used a validated microsimulation model to compare: 1) 4-6 weeks of inpatient IVA along with opioid detoxification, status quo (SQ); 2) 4-6 weeks of inpatient IVA along with inpatient addiction care services (ACS) which offers medications for opioid use disorder (SQ with ACS); 3) 3 weeks of inpatient IVA with ACS followed by OPAT (OPAT); and 4) 3 weeks of IVA with ACS followed by PO antibiotics (PO). We derived model inputs from clinical trials and observational cohorts. All patients were eligible for either in-home or post-acute care OPAT. Outcomes included life years (LYs), discounted costs, incremental cost-effectiveness ratios (ICERs), proportion of DUA-IE cured, and mortality attributable to DUA-IE. Costs (&US) were annually discounted at 3%. We performed probabilistic sensitivity analyses (PSA) to address uncertainty.ResultsThe SQ scenario resulted in 18.64 LY at a cost of &416,800/person with 77.4% hospitalized DUA-IE patients cured and 5% of deaths in the population were attributable to DUA-IE. Life expectancy was extended by each strategy: 0.017y in SQ with ACS, 0.011 in OPAT, and 0.024 in PO. The PO strategy provided the highest cure rate (80.2%), compared to 77.9% in SQ with ACS and 78.5% in OPAT and X in SQ. OPAT was the least expensive strategy at &412,300/person, Compared to OPAT, PO had an ICER of &141,500/LY. Both SQ strategies provided worse clinical outcomes for money invested than either OPAT or PO (dominated). All scenarios decreased deaths attributable to DUA-IE compared to SQ. Findings were robust in PSA.Table 1 Selected cost and clinical outcomes comparing treatment strategies for drug-use associated infective endocarditis including the status quo, status quo with addiction care services, outpatient parenteral antimicrobial therapy, and partial oral antibiotics.ConclusionTreating DUA-IE with OPAT along with ACS increases the number of people completing treatment, decreases DUA-IE mortality, and is cost-saving compared to the status quo. The PO strategy also improves clinical outcomes, but may not be cost-effective at the willingness-to-pay threshold of &100,000. Disclosures Simeon D. Kimmel, MD, MA, Abt Associates for a Massachusetts Department of Public Health project to improve access to medications for opioid use disorder in nursing facilities (Consultant)

Magnetic resonance imaging /ultrasonography fusion transperineal prostate biopsy for prostate cancer: Initial experience at a Middle Eastern tertiary medical centre

ABSTRACT Objective: To report on the outcomes of magnetic resonance imaging (MRI)/ultrasonography (US)-fusion transperineal prostate (TP) biopsy at a tertiary medical centre in the Middle East including detection rate of clinically significant prostate cancer (csPCa), complications, and tolerability of the procedure. Patients and methods: Between May 2019 and June 2020, 98 MRI/US-fusion TP biopsies were performed in the US suite using light sedation. All patients had pre-biopsy 3-T multiparametric MRI. Data on patient characteristics, PCa detection rate and complication rates were collected retrospectively. A Gleason score ≥3 + 4 was defined as csPCa. Results There were 98 patients, with a mean (SD) age of 65 (9.1) years, and a median (SD) prostate-specific antigen level prior to biopsy of 7.53 (12.97) ng/mL and prostate volume of 51 (31.1) mL. PCa was detected in 54 (55%) patients, with csPCa detected in 43 (44%). A total of 124 Prostate Imaging-Reporting and Data System (PI-RADS) 3–5 lesions were targeted. Grade Group ≥2 PCa was found in 35.5% of the targeted lesions. Random biopsies detected one csPCa Gleason score 3 + 4 in one patient with a negative target. None of the patients had post-biopsy haematuria or retention. Only one patient developed acute prostatitis requiring in-patient intravenous antibiotics. Conclusions MRI/US-fusion TP biopsy has an adequate detection rate of csPCa with minimal complications and low infection rates after biopsy. This is one of the first TP biopsy series in the Middle East paving the way for wider adoption in the region. Abbreviations AS: active surveillance; AUR: acute urinary retention; GG: Grade Group; IQR: interquartile range; mpMRI: multiparametric MRI; (cs)PCa: (clinically significant) prostate cancer; PI-RADS: Prostate Imaging-Reporting and Data System; TP: transperineal; US: ultrasonography; TRUS: transrectal Ultrasound guided.

Evaluation of Partial Oral Antibiotic Treatment for Persons Who Inject Drugs and Are Hospitalized With Invasive Infections.

Persons who inject drugs (PWID) are at risk of invasive infections; however, hospitalizations to treat these infections are frequently complicated by against medical advice (AMA) discharges. This study compared outcomes among PWID who (1) completed a full course of inpatient intravenous (IV) antibiotics, (2) received a partial course of IV antibiotics but were not prescribed any antibiotics on AMA discharge, and (3) received a partial course of IV antibiotics and were prescribed oral antibiotics on AMA discharge. A retrospective, cohort study of PWID aged ≥18 years admitted to a tertiary referral center between 01/2016 and 07/2019, who received an infectious diseases consultation for an invasive bacterial or fungal infection. 293 PWID were included in the study. 90-day all-cause readmission rates were highest among PWID who did not receive oral antibiotic therapy on AMA discharge (n = 46, 68.7%), compared with inpatient IV (n = 43, 31.5%) and partial oral (n = 27, 32.5%) antibiotics. In a multivariate analysis, 90-day readmission risk was higher among PWID who did not receive oral antibiotic therapy on AMA discharge (adjusted hazard ratio [aHR], 2.32; 95% confidence interval [CI], 1.41-3.82) and not different among PWID prescribed oral antibiotic therapy on AMA discharge (aHR, .99; 95% CI, .62-1.62). Surgical source control (aHR, .57; 95% CI, .37-.87) and addiction medicine consultation (aHR, .57; 95% CI, .38-.86) were both associated with reduced readmissions. Our single-center study suggests access to oral antibiotic therapy for PWID who cannot complete prolonged inpatient IV antibiotic courses is beneficial.

South Coast appendicular mass management (SCAM) survey.

Management of appendicular mass and interval appendicectomy remains a controversial issue. Recent publication of a randomized controlled trial (RCT) reported the incidence of around 20% neoplastic lesions in the age group of more than forty years among the interval appendicectomy group against magnetic resonance imaging (MRI) surveillance only which led to trial termination. The objective of this study is to evaluate the current practice of the management of appendicular mass in five major hospitals of South Coast of the England. A proforma was designed and emailed to the general surgical department of five hospitals in the South Coast of England. The proforma completion rate and compliance were improved by direct telephone call to the on-call registrars and consultants to collect data. Fifty-three surgeons (22 consultants, 27 ST3-ST8 grade surgical trainees and 4 SAS grades) completed the proforma. The clinical, hematological and computerized tomography (CT) based diagnostic criteria, and in-patient intravenous antibiotics (IV ABTXs) in addition to the radiological drainage in amenable cases for appendicular mass/abscess were mostly agreed initial management plan among surgeons. Normalization of inflammatory markers and radiological resolution were agreed discharge indicators. Agreed follow up investigations were CT scan (by 23%), Colonoscopy (by 13%), and both CT and colonoscopy (by 57%) after discharging patients. Only 17% surgeons offered planned interval appendicectomy and 62% surgeons offered interval appendectomy in selective cases of appendicular mass within 6 weeks to 6 months after discharge. South Coast appendicular mass management (SCAM) survey confirms diverse practice to manage appendicular mass/abscess among surgeons working in South Coast hospitals. A substantial percentage of surgeons do not offer interval appendectomy to patients potentially leaving neoplastic lesions in situ.

The Clinical Utility of Maceration Dressings in the Treatment of Inpatient Hand Infections: An Evaluation of Treatment Outcomes Compared to Standard Care.

Background: In cases of oral antibiotic-resistant infection of the hand, we propose utilizing a heated, moist maceration dressing to help shorten and simplify the in-hospital clinical course by increasing the efficacy of antibiotic deliverance to infection sites, increasing the success of nonoperative management, and decreasing eradication time of infection of the hand. Methods: Fifty-six patients older than 18 years of age who presented with hand infections requiring inpatient intravenous antibiotics at our suburban academic hospital over a 30-month period were included and randomly assigned to either the maceration dressing group or the standard treatment group. Maceration dressings included warm and moist gauze, kerlix, webril, Orthoglass, Aqua K Pad, and sling. Results: Fifty-two patients who were mostly male and younger than 60 years of age were included. Patients who used the maceration dressing had significantly shorter hospital lengths of stay (P = .02) and intravenous antibiotics duration before transition to oral antibiotics (P = .04), and decreased need for formal operating room irrigation and debridement to obtain source control (P = .02) compared to patients treated with the standard dressing. Post-hoc analysis yielded improved outcomes when using the maceration dressing regardless of whether initial bedside incision and drainage was needed to decompress a superficial abscess or not. Conclusion: The maceration dressing can be used along with proper intravenous antibiotic treatment to improve the treatment course of patients with hand infections regardless of whether the patient needs an initial bedside incision and drainage or not. Level of Evidence: Therapeutic Level II.

Rapid Admission/Discharge Process for Febrile Neutropenia

The National Comprehensive Cancer Network (NCCN) considers blood and marrow transplant (BMT) patients intermediate to high risk when treating febrile neutropenia. NCCN and the Infectious Diseases Society of America (IDSA) guidelines recommend that high risk patients should be admitted for inpatient intravenous antibiotics and monitoring. At our institution, we currently follow the standard of care recommended in the guidelines and admit hematological malignancy patients for the treatment of febrile neutropenia which has resulted in high admission rates. The primary objective is to reduce readmission rates by a rapid admission for observation and discharge process. Patients will be discharged on oral antibiotics or home infusion within 48 hours. Upon discharge patients will follow up in clinic with their healthcare provider. The secondary objective of the study is to assess physician compliance to the newly implemented checklist. This is a quality improvement project to help decrease the admission rate for febrile neutropenia in the hematological malignancy population. The focus will be on utilizing a checklist to help facilitate a rapid admission/discharge process. The checklist is comprised of high risk features that providers should assess all patients for. If patients have 2 or more of the risk factors they should remain inpatient per current standard of care otherwise patients should be discharged within 48 hours. Hematological malignancy patients admitted from October 2017- January 31st 2019 will be reviewed and compared to historical data on readmission rates at our institution. Preliminary data has shown a decrease in the length of admission (3 vs. 5 days) between patients where the protocol was utilized versus historical data. Reasons patients have not discharged within 48 hours has included clinician judgment, positive cultures and severe neutropenia. Data collection is ongoing and updated results will be presented at the meeting in February 2019.

Evaluation of white blood cell count at time of discharge is associated with limited oral antibiotic therapy in children with complicated appendicitis

BackgroundVariation exists for postoperative antibiotics in children with complicated appendicitis. We investigated the impact of white blood count (WBC) at discharge on oral antibiotic therapy, abscess rate, and readmission rate. Material/MethodsWe conducted a two year review of children with complicated appendicitis. In the pre-protocol group, total antibiotic therapy was ten days (IV and oral) and home oral antibiotics at discharge. In the post-protocol group, children with leukocytosis were prescribed oral antibiotics to complete seven days of total antibiotic therapy and children without leukocytosis were not prescribed oral home antibiotics. ResultsThere was no difference between mean hospital days after operation (3.52 vs. 3.24, p = 0.5111), means days of inpatient intravenous antibiotics (3.13 vs. 2.58, p = 0.5438), post-operative abscess rates (20.7% vs. 19.6%, p = 0.9975), or readmission rate (13.4% vs. 12.4%, p = 1.000).The post-protocol group had a shorter average total antibiotic duration (4.24 vs. 9.52 days, p < 0.001) and were more likely to be discharged without oral antibiotics (71.1% vs 8.5%, p < 0.001). DiscussionLimiting home antibiotics at discharge to children with leukocytosis significantly decreases home antibiotic use.

Granulocyte Transfusions for Neutropenic Patients with Perirectal and Perineal Infections

Granulocyte Transfusions for Neutropenic Patients with Perirectal and Perineal Infections

Outpatient management of cholesteatoma with canal wall reconstruction tympanomastoidectomy.

ObjectivesThe postoperative wound infection rate for canal wall reconstruction (CWR) tympanomastoidectomy with mastoid obliteration in the treatment of chronic otitis media with cholesteatoma has been reported to be 3.6%. Postoperative administration of 24–48 hours of intravenous antibiotics has been recommended. We aim to determine the infection rate of CWR with postoperative outpatient oral antibiotics.Study DesignInstitutional review board—approved retrospective case review.SettingTertiary referral center. Patients: Retrospective review of consecutive patients who underwent CWR tympanomastoidectomy with mastoid obliteration at a single institution from 2014 to 2016. Main Outcome Measure: Patient characteristics (age, sex) were calculated. Rate of postoperative complications and infections within 1 month of surgery were calculated. Comparison to previous published infection rates with postoperative intravenous antibiotics.Results51 patients underwent CWR followed by outpatient oral antibiotics with a mean age of 25.9 years (16 patients were less than 10 years old). There were no postoperative wound infections. Outpatient antibiotics showed non‐inferiority to IV antibiotic historic controls (0% vs. 3.6%; 95% confidence interval [CI], 0–6.09%; p = 0.03). One patient had small postoperative wound dehiscence with CSF leak that was managed conservatively. One patient developed Clostridium difficile colitis on postoperative day 2.ConclusionsThe infection rate after CWR tympanomastoidectomy with use of outpatient antibiotics is low and is non‐inferior to a historic cohort treated with inpatient intravenous antibiotics. A larger randomized controlled trial is warranted.Level of Evidence4.

Utility of Serum Procalcitonin in Skin and Soft Tissue Infections

Background Procalcitonin (PCT) has been studied as a biomarker to assist in the diagnosis and treatment of severe bacterial infections, mostly in the context of respiratory tract infections and severe sepsis, where it has been shown to reduce antimicrobial use without worsening clinical outcomes. The utility of PCT in guiding duration of antibiotic therapy in skin and soft tissue infections (SSTIs) has not been established. Our aim was to evaluate the relationship between the duration of intravenous antibiotic therapy for SSTIs and serum PCT; as well as the relationship between PCT and conventional markers of inflammation. Methods Serum PCT, leukocyte count, C-reactive protein and blood cultures laboratory, and body temperature were examined in 39 consecutive patients with SSTIs requiring inpatient intravenous antibiotic treatment. Results Thirty-nine consecutive inpatients presenting with SSTIs were evaluated. Procalcitonin values on admission correlated with duration of intravenous antibiotic therapy (Pearson correlation, 0.475; P = 0.002) and length of hospital stay (Pearson correlation, 0.534; P = 0.001). Peak serum PCT values also correlate with peak leukocyte count (Pearson correlation, 0.529; P = 0.001), peak C-reactive protein during hospitalization (Spearman correlation, 0.457; P = 0.003), and presence of Systemic Inflammatory Response Syndrome criteria on admission (P = 0.030). Conclusions Procalcitonin correlates with duration of intravenous antibiotic therapy in SSTIs; it may be a valuable adjunct in the initial diagnosis and management of antibiotic therapy in these infections.

Outpatient Laparoscopic Appendectomy in Children

The purpose of this study was to present the possibility of laparoscopic appendectomy (LA) in children as an outpatient procedure. A total of 129 pediatric patients underwent LA at our clinic from July 2009 to September 2011. As, in our treatment protocol, patients with gangrenous and perforated appendicitis would not be placed in an early-discharge list, patients who had gangrenous and perforated appendicitis (37 cases) were excluded from this study because these patients usually receive inpatient intravenous antibiotic therapy for 48 to 72 hours. Finally, 92 pediatric patients who had undergone LA for the treatment of uncomplicated appendicitis were evaluated retrospectively. Eighty-five of 92 patients (92.4%) were discharged in <24 hours and the mean postoperative length of hospital stay was 14.1 hours. Readmissions to the emergency room were not seen during the postoperative period. Complications such as wound infection, trocar site hernia, adhesive small-bowel obstruction, and abscess formation did not occur. We recommend that an LA can be performed safely as an outpatient procedure in children with uncomplicated appendicitis.

Standardized outpatient management of Klebsiella pneumoniae liver abscesses

Community-acquired Klebsiella pneumoniae has emerged as a major cause of liver abscess in Asia. Using a standardized protocol, we conducted a prospective cohort study of all cases of K. pneumoniae liver abscess treated from 2005 to 2011 at two outpatient parenteral antimicrobial therapy (OPAT) centers in Singapore, to assess the safety and efficacy of treatment. We included all OPAT eligible patients with radiologically confirmed (computed tomography or ultrasound) liver abscesses and K. pneumoniae-positive microbiological cultures obtained from abscess fluid and/or blood at two university teaching hospitals. The endpoints investigated were cure, clinical response, readmission, and mortality. All 109 patients enrolled in the study successfully completed treatment in OPAT. Nine patients required a short-term readmission due to clinical deterioration. There were no deaths or relapses at 30 days post cessation of antibiotics. Abscess size greater than 5 cm was associated with a delayed clinical response (odds ratio 5.34, 95% confidence interval 1.25-22.91, p = 0.02). The management of K. pneumoniae liver abscesses via OPAT using a standardized protocol is a safe and effective alternative to inpatient intravenous antibiotics.

Correlation of serum procalcitonin with the severity of skin and skin structure infections – a pilot study

Procalcitonin (PCT) is a specific biomarker for early detection of bacterial infections. While the usefulness of procalcitonin in severe conditions such as sepsis is well established, its relevance in the diagnosis and prognosis of localized cutaneous bacterial infections is unknown. Our aim was to initially evaluate if PCT is a useful parameter for predicting the severity of skin and skin structure infections (SSSI). Furthermore, the correlation of PCT levels with C-reactive protein (CRP), leukocyte counts, erythrocyte sedimentation rate (ESR), and body temperature was investigated. Serum PCT, routine laboratory parameters, and body temperature were regularly examined in 50 consecutive patients with SSSI requiring inpatient intravenous antibiotic treatment. Patients were classified into 2 groups according to the guidelines developed by the FDA (U.S. Food and Drug Administration) as having either an uncomplicated (SSSI) or a complicated skin and skin structure infection (cSSSI). No significant correlation could be detected between the length of inpatient antibiotic treatment and PCT on days 1, 2, 3, and the maximum value on these days. The same result was found when uncomplicated SSSI and complicated SSSI (cSSSI) were evaluated separately. However, PCT levels were significantly higher in the latter. Furthermore, PCT levels showed a significant correlation with CRP, leukocyte count, ESR, and body temperature. PCT might be a useful additional tool for initial diagnosis and monitoring of patients with SSSI.

Length of Intravenous Antibiotic Therapy and Treatment Failure in Infants With Urinary Tract Infections

The goal was to determine the association between short-duration (< or =3 days) and long-duration (> or =4 days) intravenous antibiotic therapy and treatment failure in a cohort of young infants hospitalized with urinary tract infections (UTIs). We conducted a retrospective cohort study of infants <6 months of age who were hospitalized with UTIs between 1999 and 2004 at 24 children's hospitals in the Pediatric Health Information System. Our main model adjusted for all covariates, propensity scores, and clustering according to hospital to evaluate the effect of short versus long courses of inpatient intravenous antibiotic therapy on treatment failure, defined as readmission because of UTI within 30 days. Of the 12,333 infants who met the inclusion criteria, 240 (1.9%) experienced treatment failure. The treatment failure rates were 1.6% for children who received short-course intravenous antibiotic treatment and 2.2% for children who received long-course treatment. Treatment courses varied substantially across hospitals and with patient-level characteristics. After multivariate adjustment, including propensity scores, there was no significant association between treatment group and outcomes, with an odds ratio for long versus short treatment of 1.02 (95% confidence interval: 0.77-1.35). Known presence of genitourinary abnormalities, but not age, predicted treatment failure. Treatment failure for generally healthy young infants hospitalized with UTIs is uncommon and is not associated with the duration of intravenous antibiotic treatment. Treating more infants with short courses of intravenous antibiotic therapy might decrease resource use without affecting readmission rates.

How complicated skin and soft tissue infections are treated in Italy: economic evaluation of inpatient intravenous antibiotic treatment in seven hospitals

Objectives: Complicated skin and soft tissue infections (cSSTIs) are a common cause of morbidity at hospital level. This study aimed to evaluate the costs and outcomes of inpatient intravenous antibiotic therapy for the treatment of cSSTI in seven Italian hospitals.Methods: A total of 307 patients were enrolled in a retrospective, multicentre, incidence-based, observational study. The target population consisted of hospitalised patients eligible to receive intravenous antibiotic therapy for cSSTI. Direct hospital costs were measured through a microcosting approach.Results: Failure of initial antibiotic therapy occurred in 23% of patients. Average antibiotic treatment lasted 12.2 days; the average full cost of admission totalled €5,530. If the initial antibiotic regimen fails to eradicate the infectious organism, the length of stay extends for 7 days and costs increase by €2,850 per patient. Nevertheless, when taking into account the lower intensity of care during the last days of treatment, savings reduce costs to €671 per patient. These could be increased by €74 for each hospital day avoided because of faster antibiotic action.Conclusions: Efforts should be made to minimise the risk of selecting wrong antibiotics and to identify the quickest antibiotic in eradicating the infection.

Oral antibiotic administration and early hospital discharge is a safe and effective alternative for treatment of low-risk neutropenic fever: Abstracted from: Innes HE, Smith DB, O’Reilly SM et al. Oral antibiotics with early hospital discharge compared with in-patient intravenous antibiotics for low-risk febrile neutropenia in patients with cancer: a prospective randomised controlled single centre study. British Journal of Cancer 2003;

Oral antibiotic administration and early hospital discharge is a safe and effective alternative for treatment of low-risk neutropenic fever: Abstracted from: Innes HE, Smith DB, O’Reilly SM et al. Oral antibiotics with early hospital discharge compared with in-patient intravenous antibiotics for low-risk febrile neutropenia in patients with cancer: a prospective randomised controlled single centre study. British Journal of Cancer 2003;