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Duration of Intravenous Antibiotic Therapy and Length of Stay in Community-Acquired Pneumonia
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A5537 - Duration of Intravenous Antibiotic Therapy and Length of Stay in Community-Acquired Pneumonia
Author Block: A. Elias, D. Gordon; Flinders University School of Medicine, Adelaide, Australia.
Rationale: Community-acquired pneumonia (CAP) is a common condition that imposes significant medical and financial costs on individuals and the health care system. On admission to hospital most patients receive intravenous (IV) antibiotics which are ultimately transitioned to oral medications. There are institutional guidelines which are intended to govern the switch to oral antibiotics. This research examines the degree to which this switch is conducted in accordance with clinical guidelines.
Methods: We conducted a retrospective review of adult patients admitted to Flinders Medical Centre, a 580-bed teaching hospital in Adelaide, Australia with a diagnosis of CAP over a 12-month period. Individual patient data was extracted to determine the day on which the switch to oral antibiotics should be made by guidelines. Actual day of switch to oral antibiotics, length-of-stay, duration of IV and oral therapy and the magnitude of inappropriate IV therapy were also collected.
Results: Only 38% of patients were switched to oral antibiotics on the day that they met the guidelines criteria. The mean length-of-stay for patients hospitalized with CAP was 3.3 days with a mean length of IV treatment of 3.2 days. The mean length of oral therapy whilst hospitalized was 0.54 days. The average length of IV treatment required according to the protocol was 2.54 days per patient. The duration of inappropriate IV antibiotic use was 0.87 hospital days per patient, which was 34% longer than needed. 79% of patients did not have the clinical severity of their CAP formally documented in their case notes.
Conclusion: Most patients at our institution are receiving IV antibiotics longer than necessary and clinical severity is not routinely quantified and documented by clinicians. This is likely increasing lengths-of-stay and cost.
Author Block: A. Elias, D. Gordon; Flinders University School of Medicine, Adelaide, Australia.
Rationale: Community-acquired pneumonia (CAP) is a common condition that imposes significant medical and financial costs on individuals and the health care system. On admission to hospital most patients receive intravenous (IV) antibiotics which are ultimately transitioned to oral medications. There are institutional guidelines which are intended to govern the switch to oral antibiotics. This research examines the degree to which this switch is conducted in accordance with clinical guidelines.
Methods: We conducted a retrospective review of adult patients admitted to Flinders Medical Centre, a 580-bed teaching hospital in Adelaide, Australia with a diagnosis of CAP over a 12-month period. Individual patient data was extracted to determine the day on which the switch to oral antibiotics should be made by guidelines. Actual day of switch to oral antibiotics, length-of-stay, duration of IV and oral therapy and the magnitude of inappropriate IV therapy were also collected.
Results: Only 38% of patients were switched to oral antibiotics on the day that they met the guidelines criteria. The mean length-of-stay for patients hospitalized with CAP was 3.3 days with a mean length of IV treatment of 3.2 days. The mean length of oral therapy whilst hospitalized was 0.54 days. The average length of IV treatment required according to the protocol was 2.54 days per patient. The duration of inappropriate IV antibiotic use was 0.87 hospital days per patient, which was 34% longer than needed. 79% of patients did not have the clinical severity of their CAP formally documented in their case notes.
Conclusion: Most patients at our institution are receiving IV antibiotics longer than necessary and clinical severity is not routinely quantified and documented by clinicians. This is likely increasing lengths-of-stay and cost.
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