scholarly journals Outpatient Intravenous Antibiotic Therapy: The Vancouver Hospital experience

2000 ◽  
Vol 11 (suppl a) ◽  
pp. 11A-14A ◽  
Author(s):  
Grant Stiver ◽  
Amy Wai ◽  
Lynne Chase ◽  
Luciana Frighetto ◽  
Carlo Marra ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Home Environment ◽  
Average Duration ◽  
Intravenous Therapy ◽  
Intravenous Antibiotic ◽  
Intravenous Antibiotic Therapy ◽  
Days Of Therapy ◽  
Vancouver Hospital ◽  
Infectious Disease Service ◽  
Central Catheters

From June 1, 1995 to December 31, 1997, 334 patients at the Vancouver Hospital and Health Sciences Centre (VHHSC) were referred to and screened for, outpatient intravenous antibiotic therapy. One hundred and ninety were accepted, 107 of whom were cared for under the VHHSC program and 83 of whom were discharged to continue intravenous therapy in their own health region. Thirty-four of 144 patients not accepted for outpatient intravenous therapy, were screened by the Infectious Disease Service and Pharmacy, and were discharged on oral antibiotics. Peripherally inserted central catheters were employed in 61 of 107 (57%) patients, peripheral short catheters in 20 (19%), Hickman lines in 14 (13%), and Port-a-caths in 12 (12%). Ninety-two of 107 patients treated in the VHHSC program completed their course uneventfully with resolution of the infection. The average duration of hospital therapy was 10.9 days versus 23.6 days of outpatient therapy. In 15 patients, home treatment was discontinued because of clinical deterioration: adverse drug reaction (n=2), phlebitis (n=2), unsuitable home environment (n=1), noncompliance (n=1), line-related sepsis (n=1) and death due to unrelated causes (n=1). There were 15 adverse drug reactions overall in the total of 2534 patient-days of therapy over 18 months. Cost analysis showed a cost of 12 cents on the dollar compared with inhospital therapy.

scholarly journals Potential Excess Intravenous Antibiotic Therapy in the Setting of Gram-Negative Bacteremia

Pharmacy ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 133
Author(s):  
Ashley R. Selby ◽  
Jaffar Raza ◽  
Duong Nguyen ◽  
Ronald G. Hall
Keyword(s):  
Antibiotic Therapy ◽  
Inpatient Setting ◽  
Negative Consequences ◽  
Intravenous Therapy ◽  
Intravenous Antibiotic ◽  
Gram Negative ◽  
Source Of Infection ◽  
Intravenous Antibiotic Therapy ◽  
Gram Negative Bacteremia ◽  
Wbc Count

(1) Background: Excessive intravenous therapy (EIV) is associated with negative consequences, but guidelines are unclear about when switching to oral therapy is appropriate. (2) Methods: This cohort included patients aged ≥18 years receiving ≥48 h of antimicrobial therapy for bacteremia due to Escherichia coli, Pseudomonas aeruginosa, Enterobacter, Klebsiella, Acinetobacter, or Stenotrophomonas maltophilia from 1/01/2008–8/31/2011. Patients with a polymicrobial infection or recurrent bacteremia were excluded. Potential EIV (PEIV) was defined as days of intravenous antibiotic therapy beyond having a normal WBC count for 24 h and being afebrile for 48 h until discharge or death. (3) Results: Sixty-nine percent of patients had PEIV. Patients who received PEIV were more likely to receive intravenous therapy until discharge (46 vs. 16%, p < 0.001). Receipt of PEIV was associated with a longer mean time to receiving oral antimicrobials (8.7 vs. 3 days, p < 0.001). The only factors that impacted EIV days in the multivariable linear regression model were the source of infection (urinary tract) (coefficient −1.54, 95%CI −2.82 to −0.26) and Pitt bacteremia score (coefficient 0.51, 95%CI 0.10 to 0.92). (4) Conclusions: PEIV is common in inpatients with Gram-negative bacteremia. Clinicians should look to avoid PEIV in the inpatient setting.

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.

scholarly journals Effectiveness of early switching from intravenous to oral antibiotic therapy in Staphylococcus aureus prosthetic bone and joint or orthopedic metalware-associated infections

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hélène Boclé ◽  
Jean-Philippe Lavigne ◽  
Nicolas Cellier ◽  
Julien Crouzet ◽  
Pascal Kouyoumdjian ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Antibiotic Therapy ◽  
Treatment Failure ◽  
Cox Model ◽  
University Hospital ◽  
Empiric Antibiotic Therapy ◽  
Oral Antibiotic ◽  
Intravenous Antibiotic ◽  
Oral Antibiotic Therapy ◽  
Intravenous Antibiotic Therapy

Abstract Background The optimal duration of intravenous antibiotic therapy in Staphylococcus aureus prosthetic bone and joint infection has not been established. The objective of this study was to compare the effect of early and late intravenous-to-oral antibiotic switch on treatment failure. Patients and methods We retrospectively analyzed all adult cases of S. aureus prosthetic bone and joint or orthopedic metalware-associated infection between January 2008 and December 2015 in a French university hospital. The primary outcome was treatment failure defined as the recurrence of S. aureus prosthetic bone and joint or orthopedic metalware-associated infection at any time during or after the first line of medical and surgical treatment within 2 years of follow-up. A Cox model was created to assess risk factors for treatment failure. Results Among the 140 patients included, mean age was 60.4 years (SD 20.2), and 66% were male (n = 92). Most infections were due to methicillin-susceptible S. aureus (n = 113, 81%). The mean duration of intravenous antibiotic treatment was 4.1 days (SD 4.6). The majority of patients (119, 85%) had ≤5 days of intravenous therapy. Twelve patients (8.5%) experienced treatment failure. Methicillin-resistant S. aureus infections (HR 11.1; 95% CI 1.5–111.1; p = 0.02), obesity (BMI > 30 kg/m2) (HR 6.9; 95% CI1.4–34.4, p = 0.02) and non-conventional empiric antibiotic therapy (HR 7.1; 95% CI 1.8–25.2; p = 0.005) were significantly associated with treatment failure, whereas duration of intravenous antibiotic therapy (≤ 5 or > 5 days) was not. Conclusion There was a low treatment failure rate in patients with S. aureus prosthetic bone and joint or orthopedic metalware-associated infection with early oral switch from intravenous to oral antibiotic therapy.

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