Effectiveness of sequential intravenous-to-oral antibiotic switch therapy in hospitalized patients with gram-positive infection: the SEQUENCE cohort study.

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.

Impact of local guidelines and an integrated dispensing system on antibiotic prophylaxis quality in a surgical centre.

Surgical antibiotic prophylaxis is effective in preventing postoperative wound infections. Guidelines are designed to optimize antimicrobial use in this setting. The aim of this study was to assess antibiotic use in surgical prophylaxis in a surgical hospital before and after the implementation of both local antibiotic prophylaxis guidelines and a specific medication set for various surgical procedures. The appropriateness of surgical antibiotic prophylaxis increased from 50.9% in the pre-implementation stage to 94.9% in the postimplementation stage (P<0.001). The implementation of a multidisciplinary protocol and design of medication sets helped to improve the practice of surgical antibiotic prophylaxis.

[Use of levofloxacin in the hospital]. / Utilización hospitalaria de levofloxacino.

Levofloxacin is a new, recently commercialized fluoroquinolone. We aimed to assess the use of levofloxacin after its inclusion in the hospital drug guide. In a prospective observational study, patients treated with levofloxacin in a university hospital were selected from July 2000 to June 2001. Using a structured questionnaire, data were recorded on patients' demographic characteristics and comorbidities, indications for levofloxacin use and previous use of other antibiotics. In addition, the adherence to the instructions for use as recommended by the antibiotic subcommittee of the hospital, and the use of other alternative antibiotics were analyzed. Ninety-seven patients were treated [mean age 67 years; range 17-93; 64 men], of whom 83 (85.6%) had comorbidity and 51 (52.6%) a possible allergy to the betalactam antibiotics. The treatment began after the use of other antibiotics in 47 (48.5%) patients. The main clinical indications were pneumonia (54; 55.7%) and acute exacerbation of chronic bronchitis (25; 25.8%). The use of other antibiotics was possible in 56 (57.7%) patients, and levofloxacin was only used according to the recommended indications in 41 (42.3%). Levofloxacin is mainly used in the treatment of patients with respiratory infections, those who are allergic to the betalactam antibiotics and those previously treated with other antibiotics; however, in many cases, the use of other antibiotics may still be possible. As part of the antibiotic policy, it is necessary to define the indications of use for new antibiotics introduced in the hospital and surveillance studies need to be developed.

Utilización hospitalaria de levofloxacino / Use of levofloxacin in the hospital

El objetivo del estudio fue evaluar el uso de levofloxacino después de su inclusión en la guía hospitalaria de medicamentos. Fue un estudio observacional prospectivo (julio 2000-junio 2001) en el cual se seleccionaron los pacientes tratados con levofloxacino en un hospital universitario. Mediante un cuestionario estructurado se recogieron datos sobre las características demográficas y comorbilidad de los pacientes, indicaciones de uso y uso previo de otros antibióticos. Además, se analizó la adecuación a las indicaciones de uso recomendadas por la subcomisión de antibióticos del hospital y el uso de otros antibióticos alternativos. Se trataron 97 pacientes (edad mediana 67 años, rango 17-93; 64 hombres), de los cuales 83 (85,6 por ciento) tenían comorbilidad y 51 (52,6 por ciento) una posible alergia a los betalactámicos. Se inició el tratamiento después del uso de otros antibióticos en 47 (48,5 por ciento) pacientes. Las principales indicaciones clínicas fueron neumonía (54; 55,7 por ciento) y sobreinfecciones respiratorias (25; 25,8 por ciento). En 56 (57,7 por ciento) pacientes era posible el uso de otros antibióticos alternativos y sólo en 41 (42,3 por ciento) se utilizó según las indicaciones recomendadas. Levofloxacino se utiliza sobre todo en el tratamiento de pacientes con infecciones respiratorias, alérgicos a los betalactámicos y tratados previamente con otros antibióticos, aunque en muchos casos todavía sea posible el uso de otros antibióticos. Dentro de la política de antibióticos es necesario definir las indicaciones para los nuevos antibióticos introducidos en el hospital y el desarrollo de estudios de seguimiento después de su inclusión (AU)

Monitoring of antimicrobial therapy by an integrated computer program.

OBJECTIVE: To assess the impact of the setting-up of a computer program designed by the Hospital Pharmacy Department as a tool that provides information for the antimicrobial therapy monitoring. To assess its influence on pharmaceutical costs. MATERIAL AND METHOD: The computer application for the follow-up of antimicrobial treatments integrates information from the Pharmacy Department and the Microbiology Laboratory and selects all patients to whom some controlled antibiotic has been prescribed. The pharmacist reviews all the controlled antibiotic treatments, suggests any change to the physician if needed and quantifies the economic impact of the accepted interventions. RESULTS: On average, 12.5% of controlled antibiotic treatments warranted a pharmaceutical intervention, and 92% of them were accepted. The most frequent interventions related to prescriptions were change of dosage and administration route and related to the disease were in respiratory and urinary tract infections. From the economic point of view, the accepted interventions represented a saving of 12,087,029 pesetas (83,359 $)/year, on average. CONCLUSION: The applied computer program resulted a useful tool for a clinical pharmacist to reach more correct antibiotical therapeutics and better cost-effectiveness relation. It also helped to achieve favorable clinical outcomes.