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

(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 Esche...

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Autores principales: Selby, Ashley R., Raza, Jaffar, Nguyen, Duong, Hall 2nd, Ronald G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8396368/
https://www.ncbi.nlm.nih.gov/pubmed/34449693
http://dx.doi.org/10.3390/pharmacy9030133
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author Selby, Ashley R.
Raza, Jaffar
Nguyen, Duong
Hall 2nd, Ronald G.
author_facet Selby, Ashley R.
Raza, Jaffar
Nguyen, Duong
Hall 2nd, Ronald G.
author_sort Selby, Ashley R.
collection PubMed
description (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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spelling pubmed-83963682021-08-28 Potential Excess Intravenous Antibiotic Therapy in the Setting of Gram-Negative Bacteremia Selby, Ashley R. Raza, Jaffar Nguyen, Duong Hall 2nd, Ronald G. Pharmacy (Basel) Communication (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. MDPI 2021-08-03 /pmc/articles/PMC8396368/ /pubmed/34449693 http://dx.doi.org/10.3390/pharmacy9030133 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Communication
Selby, Ashley R.
Raza, Jaffar
Nguyen, Duong
Hall 2nd, Ronald G.
Potential Excess Intravenous Antibiotic Therapy in the Setting of Gram-Negative Bacteremia
title Potential Excess Intravenous Antibiotic Therapy in the Setting of Gram-Negative Bacteremia
title_full Potential Excess Intravenous Antibiotic Therapy in the Setting of Gram-Negative Bacteremia
title_fullStr Potential Excess Intravenous Antibiotic Therapy in the Setting of Gram-Negative Bacteremia
title_full_unstemmed Potential Excess Intravenous Antibiotic Therapy in the Setting of Gram-Negative Bacteremia
title_short Potential Excess Intravenous Antibiotic Therapy in the Setting of Gram-Negative Bacteremia
title_sort potential excess intravenous antibiotic therapy in the setting of gram-negative bacteremia
topic Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8396368/
https://www.ncbi.nlm.nih.gov/pubmed/34449693
http://dx.doi.org/10.3390/pharmacy9030133
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