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

AR Selby, J Raza, D Nguyen, RG Hall 2nd - Pharmacy, 2021 - mdpi.com
AR Selby, J Raza, D Nguyen, RG Hall 2nd
Pharmacy, 2021mdpi.com
(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 …
(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.
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