scholarly journals Effect of a 3-Step Critical Pathway to Reduce Duration of Intravenous Antibiotic Therapy and Length of Stay in Community-Acquired Pneumonia

2012 ◽  
Vol 172 (12) ◽  
Author(s):  
Jordi Carratalà ◽  
Carolina Garcia-Vidal ◽  
Lucía Ortega ◽  
Núria Fernández-Sabé ◽  
Mercedes Clemente ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Antibiotic Therapy ◽  
Community Acquired Pneumonia ◽  
Intravenous Antibiotic ◽  
Critical Pathway ◽  
Intravenous Antibiotic Therapy

scholarly journals A Pathway for Community-Acquired Pneumonia With Rapid Conversion to Oral Therapy Improves Health Care Value

2020 ◽  
Vol 7 (11) ◽  
Author(s):  
Claire E Ciarkowski ◽  
Tristan T Timbrook ◽  
Polina V Kukhareva ◽  
Karli M Edholm ◽  
Nathan D Hatton ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Antimicrobial Stewardship ◽  
Academic Medical Center ◽  
Community Acquired Pneumonia ◽  
Phase 2 ◽  
Intravenous Antibiotic ◽  
Phase 3 ◽  
Baseline Phase ◽  
Intravenous Antibiotic Therapy ◽  
The Impact

Abstract Background Evidence supports streamlined approaches for inpatients with community-acquired pneumonia (CAP) including early transition to oral antibiotics and shorter therapy. Uptake of these approaches is variable, and the best approaches to local implementation of infection-specific guidelines are unknown. Our objective was to evaluate the impact of a clinical decision support (CDS) tool linked with a clinical pathway on CAP care. Methods This is a retrospective, observational pre–post intervention study of inpatients with pneumonia admitted to a single academic medical center. Interventions were introduced in 3 sequential 6-month phases; Phase 1: education alone; Phase 2: education and a CDS-driven CAP pathway coupled with active antimicrobial stewardship and provider feedback; and Phase 3: education and a CDS-driven CAP pathway without active stewardship. The 12 months preceding the intervention were used as a baseline. Primary outcomes were length of intravenous antibiotic therapy and total length of antibiotic therapy. Clinical, process, and cost outcomes were also measured. Results The study included 1021 visits. Phase 2 was associated with significantly lower length of intravenous and total antibiotic therapy, higher procalcitonin lab utilization, and a 20% cost reduction compared with baseline. Phase 3 was associated with significantly lower length of intravenous antibiotic therapy and higher procalcitonin lab utilization compared with baseline. Conclusions A CDS-driven CAP pathway supplemented by active antimicrobial stewardship review led to the most robust improvements in antibiotic use and decreased costs with similar clinical outcomes.

Home intravenous antibiotic therapy

1993 ◽  
Vol 94 (1) ◽  
pp. 114 ◽  
Author(s):  
David T. Durack ◽  
A.W. Karchmer ◽  
Ralph Blair ◽  
auWalter Wilson ◽  
William Dismukes ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Intravenous Antibiotic ◽  
Intravenous Antibiotic Therapy

Management of complicated shunt infections: a clinical report

2008 ◽  
Vol 1 (3) ◽  
pp. 223-228 ◽  
Author(s):  
Hector E. James ◽  
John S. Bradley
Keyword(s):  
Antibiotic Therapy ◽  
Treatment Protocol ◽  
Shunt Infection ◽  
The Body ◽  
Clinical Report ◽  
Intravenous Antibiotic ◽  
Once Daily ◽  
Intravenous Antibiotic Therapy ◽  
Shunt Infections

Object The authors present their experience with a protocol for the treatment of patients with complicated shunt infections. Methods Complicated shunt infections are defined for the purpose of this protocol as multiple compartment hydrocephalus, multiple organism shunt infection, severe peritonitis, or infections in other sites of the body. The initial treatment protocol for these patients was 3 weeks of intravenous antibiotic therapy and 2 weeks of twice daily intraventricular/intrashunt antibiotic therapy. Cerebrospinal fluid (CSF) cultures were monitored during therapy and obtained again 48 hours after completion. The shunt was completely replaced. Additionally, follow-up cultures were obtained in all patients 3–6 months after therapy was completed. Results A cure of the infection was achieved in all patients as defined by negative cultures obtained at completion of antibiotic therapy and in follow-up studies. The follow-up period was 2–11 years (mean 4.4 ± 2.5 years). The treatment protocol was modified in the patients treated after 1991, and 18 patients were treated with this modified treatment regime. In these patients, intraventricular antibiotics were administered only once daily for 14 days, and the CSF was cultured 24 hours after antibiotic therapy had been stopped instead of after 48 hours. The results were similar to those obtained with the initial protocol. Conclusions Based on their prospective nonrandomized series, the authors believe that patients with complicated shunt infections can be successfully treated with 2 weeks of intraventricular antibiotic therapy administered once daily, concurrent with 3 weeks of intravenous antibiotic therapy. This protocol reduces length of treatment and hospital stay, and avoids recurrence of infection.

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