Effectiveness of sequential intravenous-to-oral antibiotic switch therapy in hospitalized patients with gram-positive infection : the SEQUENCE cohort study
Rodriguez-Pardo, Dolors (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Pigrau, C. (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Campany, D. (Hospital Universitari Vall d'Hebron)
Diaz-Brito, Vicens (Department of Internal Medicine, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain)
Morata, Laura (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
de Diego, I. C. (Hospital Arnau de Vilanova (Lleida, Catalunya))
Sorlí, Luisa (Institut Hospital del Mar d'Investigacions Mèdiques)
Iftimie, S. (Hospital Universitari Sant Joan de Reus (Tarragona))
Pérez-Vidal, Rafel (Hospital Sant Joan de Déu (Manresa))
García-Pardo, Graciano (Hospital Universitari Joan XXIII de Tarragona)
Larrainzar-Coghen, T. (Hospital Universitari Vall d'Hebron)
Almirante Gragera, Benito (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Universitat Autònoma de Barcelona

Data:	2016
Resum:	Switching from intravenous to oral antibiotic therapy may improve inpatient management and reduce hospital stays and the complications of intravenous treatment. We aimed to assess the effectiveness of intravenous-to-oral antibiotic switch therapy and an early discharge algorithm in hospitalized patients with gram-positive infection. We performed a prospective cohort study with a retrospective comparison cohort, recruited from eight tertiary, acute-care Spanish referral hospitals. All patients included had culture-confirmed methicillin-resistant gram-positive infection, or methicillin-susceptible gram-positive infection and beta-lactam allergy and had received intravenous treatment with glycopeptides, lipopeptides, or linezolid. The study comprised two cohorts: the prospective cohort to assess the effectiveness of a sequential intravenous-to-oral antibiotic switch algorithm and early discharge, and a retrospective cohort in which the algorithm had not been applied, used as the comparator. A total of 247 evaluable patients were included; 115 in the prospective and 132 in the retrospective cohort. Forty-five retrospective patients (34 %) were not changed to oral antibiotics, and 87 (66 %) were changed to oral antibiotics without following the proposed algorithm. The duration of hospitalization was significantly shorter in the prospective cohort compared to the retrospective group that did not switch to oral drugs (16. 7 ± 18. 7 vs 23 ± 13. 4 days, P < 0. 001). No differences were observed regarding the incidence of catheter-related bacteraemia (4. 4 % vs 2. 6 %, P = 0. 621). Our results suggest that an intravenous-to-oral antibiotic switch strategy is effective for reducing the length of hospital stay in selected hospitalized patients with gram-positive infection.
Ajuts:	Instituto de Salud Carlos III REIPI RD12-0015
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	European journal of clinical microbiology & infectious diseases, Vol. 35 (may 2016) , p. 1269-1276, ISSN 1435-4373

DOI: 10.1007/s10096-016-2661-5
PMID: 27180242

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