Clinical Experience of Implementing Oral Versus Intravenous Antibiotics (OVIVA) in a Specialist Orthopedic Hospital

2020 ◽  
Author(s):  
Tariq Azamgarhi ◽  
Ashik Shah ◽  
Simon Warren
Keyword(s):  
Clinical Practice ◽  
Joint Infection ◽  
Hospital Readmissions ◽  
Length Of Hospital Stay ◽  
Oral Antibiotic ◽  
Antibiotic Regimen ◽  
Prospective Data ◽  
Parenteral Antibiotic ◽  
Real World Setting ◽  
Intravenous Antibiotics

Abstract Background The Oral Versus Intravenous Antibiotics (OVIVA) Trial demonstrated that oral therapy, when used during the initial 6 weeks in the treatment in bone and joint infection (BJI), is noninferior to intravenous therapy. To date there are no reports describing reproducibility of these findings in a real-world setting. Methods We studied all patients diagnosed with BJI at our hospital 12 months pre- and postimplementation of the OVIVA trial findings into clinical practice. An infection consultant recommended antibiotic treatment and patients were followed up by an outpatient parenteral antibiotic therapy (OPAT) service. Prospective data from a local registry was used to analyze baseline clinical details, outcome, length of hospital stay (LOS), and costs. Results A cohort of 328 patients (145 pre- and 183 postimplementation) was analyzed. Postimplementation, 66.1% of patients were switched to a suitable oral antibiotic regimen. Definite failure at 1 year was 13.6% in the preimplementation group and 18.6% in the postimplementation group (P = .154). Postimplementation, definite failure was more common in patients requiring intravenous antibiotics due to lack of suitable oral options (intravenous, 26.7% and oral, 14.3%). Adverse drug reactions (ADRs) requiring closer monitoring or change to treatment were more common postimplementation (21.0% and 37.1%, respectively). ADR-related hospital readmissions were similar in both groups (2.1 and 2.2%). Comparing both groups, the postimplementation group showed a reduction of 4 days in the median LOS and a median cost reduction of £2764.28 per patient. Conclusions The OVIVA trial findings can be safely implemented into clinical practice when patients on oral antibiotics are followed up by an established OPAT service. Two-thirds of patients were switched to a suitable oral antibiotic regimen. Implementation led to reductions in hospital LOS and antibiotic costs.

scholarly journals PARENTERAL ANTIBIOTIC USAGE PATTERNS AND EFFECTS OF INTRAVENOUS TO ORAL SWITCHING ON THE LENGTH AND COST OF HOSPITALIZATION

2017 ◽  
Vol 9 ◽  
pp. 85
Author(s):  
Rengganis Pranandari ◽  
Sudibyo Supardi ◽  
Retnosari Andrajati
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Chi Square ◽  
Parenteral Antibiotic ◽  
Exact Test ◽  
Hospitalization Cost ◽  
Switching Patterns ◽  
Intravenous Antibiotics ◽  
Usage Patterns ◽  
The Cost

Objective: The prolonged use of intravenous antibiotics might increase the length and cost of hospitalization. The research objective, therefore, was toevaluate the effect of switching antibiotics on the length of hospital stay and hospitalization cost. The prospective cohort research design was adopted.The inclusion criteria were in patients who had received intravenous antibiotics.Methods: The sample comprised 39 patients who switched antibiotics as an exposed group and 39 patients who did not switch as an unexposedgroup. The data were collected using the patient medical records and the financial data from the hospital information system. The Mann–Whitney testand Chi-square or Fisher’s exact test was applied in the analysis.Results: The results revealed that the antibiotics most commonly switched were intravenous ceftriaxone (83.3%) and oral cefixime (94.8%). From thefive switching patterns observed, the most common switch was from intravenous ceftriaxone to oral cefixime in patients with acute gastroenteritis.All antibiotics were administered in accordance with the National Formulary (NF) guidelines. Only metronidazole (5 mg/ml dose) was inconsistentwith NF. Switching antibiotics did not impact the length of hospital stay and hospitalization cost; however, comorbidities did have an influence here.Conclusions: Further, switching antibiotics impacted the duration over which intravenous antibiotics were administered and the cost of antibiotics.

scholarly journals Retrospective analysis of endocarditis patients to investigate the eligibility for oral antibiotic treatment in routine daily practice

2020 ◽  
Author(s):  
J. C. Vroon ◽  
O. C. D. Liesdek ◽  
C. H. E. Boel ◽  
J. E. Arends ◽  
F. A. Niessen ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Infective Endocarditis ◽  
Hospital Stay ◽  
Antibiotic Treatment ◽  
Oral Treatment ◽  
Daily Practice ◽  
Oral Antibiotic ◽  
Intravenous Antibiotics ◽  
European Society Of Cardiology ◽  
Stable Clinical Condition

Abstract Background According to the current guidelines of the European Society of Cardiology, patients with left-sided infective endocarditis are treated with intravenous antibiotics for 4–6 weeks, leading to extensive hospital stay and high costs. Recently, the Partial Oral Treatment of Endocarditis (POET) trial suggested that partial oral treatment is effective and safe in selected patients. Here, we investigated if such patients are seen in our daily clinical practice. Methods We enrolled 119 adult patients diagnosed with left-sided infective endocarditis in a retrospective, observational study. We identified those that would be eligible for switching to partial oral antibiotic treatment as defined in the POET trial (e.g. stable clinical condition without signs of infection). Secondary objectives were to provide insight into the time until each patient was eligible for partial oral treatment, and to determine parameters of longer hospital stay and/or need for extended intravenous antibiotic treatment. Results Applying the POET selection criteria, the condition of 38 patients (32%) was stable enough to switch them to partial oral treatment, of which 18 (47.3%), 8 (21.1%), 9 (23.7%) and 3 patients (7.9%) were eligible for switching after 10, 14, 21 days or 28 days of intravenous treatment, respectively. Conclusion One-third of patients who presented with left-sided endocarditis in routine clinical practice were possible candidates for switching to partial oral treatment. This could have major implications for both the patient’s quality of life and healthcare costs. These results offer an interesting perspective for implementation of such a strategy, which should be accompanied by a prospective cost-effectiveness analysis.

scholarly journals Oral and Parenteral versus Parenteral Antibiotic Prophylaxis for Patients Undergoing Laparoscopic Colorectal Resection: An Intervention Review with Meta-Analysis

Antibiotics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 21
Author(s):  
Giuseppe Sangiorgio ◽  
Marco Vacante ◽  
Francesco Basile ◽  
Antonio Biondi
Keyword(s):  
Antibiotic Prophylaxis ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Oral Antibiotic ◽  
Oral Antibiotics ◽  
Parenteral Antibiotic ◽  
Search Filter ◽  
Colorectal Cancer Resection ◽  
Intravenous Antibiotics

This study aims to systematically assess the efficacy of parenteral and oral antibiotic prophylaxis compared to parenteral-only prophylaxis for the prevention of surgical site infection (SSI) in patients undergoing laparoscopic surgery for colorectal cancer resection. Published and unpublished randomized clinical trials comparing the use of oral and parenteral prophylactic antibiotics versus parenteral-only antibiotics in patients undergoing laparoscopic colorectal surgery were collected searching electronic databases (MEDLINE, CENTRAL, EMBASE, SCIENCE CITATION INDEX EXPANDED) without limits of date, language, or any other search filter. The outcomes included SSIs and other infectious and noninfectious postoperative complications. Risk of bias was assessed using the Cochrane revised tool for assessing risk of bias in randomized trials (RoB 2). A total of six studies involving 2252 patients were finally included, with 1126 cases in the oral and parenteral group and 1126 cases in the parenteral-only group. Meta-analysis results showed a statistically significant reduction of SSIs (OR 0.54, 95% CI 0.40 to 0.72; p < 0.0001) and anastomotic leakage (OR 0.55, 95% CI 0.33 to 0.91; p = 0.02) in the group of patients receiving oral antibiotics in addition to intravenous (IV) antibiotics compared to IV alone. Our meta-analysis shows that a combination of oral antibiotics and intravenous antibiotics significantly lowers the incidence of SSI compared with intravenous antibiotics alone.

Features of the complex treatment of ulcerative colitis in clinical practice

2020 ◽  
pp. 6-11
Author(s):  
Svetlana Svetlana ◽  
Mikhail Klimentov ◽  
Olga Neganova ◽  
Alina Nazmieva ◽  
Anastasiya Kochurova
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Practice ◽  
Statistical Study ◽  
Age Groups ◽  
Length Of Hospital Stay ◽  
Unknown Etiology ◽  
Number Of Patients ◽  
First Republic ◽  
Bowel Diseases ◽  
Inflammatory Bowel

Nowadays there are certain difficulties in the early diagnosis of ulcerative colitis, proceeding with minimal intestinal symptoms. The etiology of the disease remains unclear to this day; there is no exact information about the prevalence of the disease due to the large number of latent forms and the low number of patients seeking medical help. This article presents the results of a retrospective analysis of the incidence of ulcerative colitis in the coloproctology department of the First Republic Clinical Hospital of Izhevsk. The study was conducted to assess the frequency of occurrence and determine the internal picture of ulcerative colitis. To achieve this goal, we selected 34 patients with ulcerative colitis. A statistical study was conducted on the following criteria: gender composition, age groups, forms of the disease, localization, complications, and main complaints. The length of hospital stay often was not more than 20 days. The literature on this pathology was also studied and presented in the form of a theoretical basis, which consisted of the determination and etiology of inflammatory bowel diseases. Due to the unknown etiology, insufficiently studied pathogenesis, difficult differential diagnosis with other intestinal diseases and insufficiently perfect treatment methods, there are a large number of unresolved problems in the field of ulcerative colitis. That is why, in this article we tried to reveal the problem of the features of the course and complex therapy of that disease in clinical practice.

scholarly journals Ampicillin-Ceftriaxone vs Ampicillin-Gentamicin for Definitive Therapy of Enterococcus faecalis Infective Endocarditis: A Propensity Score–Matched, Retrospective Cohort Analysis

2021 ◽  
Vol 8 (4) ◽  
Author(s):  
Niyati H Shah ◽  
Kathleen A Shutt ◽  
Yohei Doi
Keyword(s):  
Infective Endocarditis ◽  
Propensity Score ◽  
Adverse Events ◽  
Cohort Analysis ◽  
Hospital Readmissions ◽  
Length Of Hospital Stay ◽  
The United States ◽  
Aminoglycoside Resistance ◽  
Definitive Therapy ◽  
Significant Difference

Abstract Background Ampicillin-ceftriaxone (AC) has emerged as an alternative antibiotic regimen for enterococcal infective endocarditis (EIE) with reduced toxicity compared with ampicillin-gentamicin (AG), but evidence regarding its success in reducing EIE-associated death in the United States is limited. Methods We conducted a retrospective, propensity score–matched cohort analysis of EIE patients treated with AC or AG between 2010 and 2017 at 3 hospitals in Pittsburgh, Pennsylvania. We assessed all-cause 90-day mortality as the primary outcome and in-hospital mortality, length of hospital stay, hospital readmissions, adverse events, and relapse of bacteremia as the secondary outcomes. Results A total of 190 patients with EIE (100 treated with AC and 90 with AG) were included. Ninety-day mortality was significantly higher with AC than AG (21% vs 8%; P = .02). After propensity score matching, 56 patients in each group remained for the outcomes analysis. Documented aminoglycoside resistance, presence of annular or aortic abscess, and complete pacemaker removal were the significantly different variables between the 2 matched cohorts. We observed no statistically significant difference in 90-day mortality between the 2 treatment groups (11% vs 7%; P = .55). Adverse events were more common in patients treated with AG (25 vs 39; P = .0091), and more patients in the propensity score–matched AG cohort switched antibiotic regimens than in the AC group (10% vs 49%; P &lt; .0001). Conclusions Patients treated with AC demonstrate no significant differences in mortality, treatment failure, or bacteremia relapse compared with AG in a propensity score–matched EIE cohort.

scholarly journals Periprocedural Peritonitis Prophylaxis: A Summary of the Microbiology and the Role of Systemic Antimicrobials

2021 ◽  
Vol 7 (2) ◽  
pp. 90-99
Author(s):  
Leon Hsueh ◽  
Susie L. Hu ◽  
Ankur D. Shah
Keyword(s):  
Peritoneal Dialysis ◽  
High Risk ◽  
Antibiotic Prophylaxis ◽  
Catheter Insertion ◽  
Antibiotic Regimen ◽  
Dental Procedures ◽  
Intravenous Antibiotics ◽  
Skin Flora ◽  
Potential Strategy

Background: Peritonitis is a leading complication of peritoneal dialysis (PD). One strategy that the International Society for Peritoneal Dialysis (ISPD) has used to help mitigate the morbidity and mortality associated with peritonitis is through prevention, including antibiotic prophylaxis utilization in high-risk situations. The aim of this study is to summarize our current understanding of postprocedural peritonitis and discuss the existing data behind periprocedural antibiotic prophylaxis, focusing primarily on PD catheter insertion, dental procedures, colonoscopies, upper endoscopies with gastrostomy, and gynecologic procedures. Summary: The ISPD currently recommends intravenous antibiotics prior to PD catheter insertion, colonoscopies, and invasive gynecologic procedures, though prophylaxis has only demonstrated benefit in a prospective, randomized control setting for PD catheter insertion. However, multiple retrospective studies exist that support the use of antibiotic prophylaxis for the other 2 procedures. No specific antibiotic regimen has been established as most optimal to prevent peritonitis for any of the 3 procedures. Antibiotic coverage should include the Enterobacteriaceae family, as well as Gram-positive organisms commonly found on the skin flora for PD catheter insertion, anaerobes for colonoscopies, and common organisms from the urogenital flora in gynecologic procedures. Additionally, the ISPD currently recommends oral amoxicillin prior to dental procedures. There is currently no ISPD recommendation to provide antibiotic prophylaxis prior to an upper endoscopy with or without gastrostomy, though this is a potential area for research. Key Messages: PD patients are at high risk for developing peritonitis after typical procedures. Antibiotic prophylaxis is a potential strategy that the ISPD utilizes to prevent these infections. However, further research needs to be done to determine the optimal antibiotic regimen.

scholarly journals ISMAR-study presentation: in-hospital epidemiology and clinical management of respiratory and cardiac comorbidities in cardiac and respiratory disease units

2014 ◽  
Vol 9 ◽  
Author(s):  
Roberto Tramarin ◽  
Mario Polverino ◽  
Maurizio Volterrani ◽  
Bruna Girardi ◽  
Claudio Chimini ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Management ◽  
Real Life ◽  
Length Of Hospital Stay ◽  
Relevant Information ◽  
Hospital Epidemiology ◽  
Discharge Data ◽  
Definition Of ◽  
Current Guidelines

Background: Cardiovascular and respiratory diseases are leading causes of morbidity and their co-occurrence has important implications in mortality and other outcomes. Even the most recent guidelines do not reliably address clinical, prognostic, and therapeutic concerns due to the overlap of respiratory and cardiac diseases. Study objectives and design: In order to evaluate in the reality of clinical practice the epidemiology and the reciprocal impact of cardio-pulmonary comorbidity on the clinical management, diagnostic workup and treatment, 1,500 cardiac and 1,500 respiratory inpatients, admitted in acute and rehabilitation units, will be enrolled in a multicenter, nationwide, prospective observational study. For this purpose, each center will enroll at least 50 consecutive patients. At discharge, data analysis will be aimed at the definition of cardiac and pulmonary inpatient comorbidity prevalence, demographic characteristics, length of hospital stay, and risk factors, taking into account also procedures, pharmacological and non-pharmacological treatment, and follow up in patients with cardio-respiratory comorbidity. Conclusions: The purely observational design of the study aims to give new relevant information on the assessment and management of overlapping patients in real life clinical practice, and new insight for improvement and implementation of current guidelines on the management of individual diseases.

scholarly journals Syndrome of inappropriate secretion of antidiuretic hormone in the practice of endocrinologist

2021 ◽  
Vol 14 (3) ◽  
pp. 4-12
Author(s):  
Agunda V. Dzagaxova ◽  
Nino N. Katamadze ◽  
Ekaterina A. Pigarova
Keyword(s):  
Clinical Practice ◽  
Antidiuretic Hormone ◽  
Clinical Guidelines ◽  
Length Of Hospital Stay ◽  
Interdisciplinary Approach ◽  
Electrolyte Balance ◽  
Electrolyte Disorders ◽  
Inappropriate Secretion ◽  
Wide Range ◽  
Water And Electrolyte Balance

Hyponatremia is the most common disorder of water and electrolyte balance encountered in clinical practice. Conditions associated with hyponatremia require hospitalization in 15–20% of cases. Hyponatremia is a predictor of poor outcome in a wide range of diseases and therefore requires an interdisciplinary approach. This problem leads to an increase in complications and the length of hospital stay and mortality. The review focuses on the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), which accounts for approximately one third of all cases of hyponatremia and is more common in endocrinology than other fluid and electrolyte disorders along with central diabetes insipidus. The article presents modern approaches to the treatment of SIADH based on international clinical guidelines.

Medically managed prosthetic valve endocarditis caused by Salmonella enteritidis

2021 ◽  
Vol 14 (6) ◽  
pp. e237679
Author(s):  
Gavin Connolly ◽  
Mita Kale ◽  
Andrew Ustianowski
Keyword(s):  
Prosthetic Valve ◽  
Salmonella Enteritidis ◽  
Prosthetic Valve Endocarditis ◽  
Good Health ◽  
Prosthetic Material ◽  
Oral Antibiotic ◽  
Rare Occurrence ◽  
Combined Surgery ◽  
Oral Antibiotic Therapy ◽  
Intravenous Antibiotics

Infective endocarditis is associated with morbidity and mortality even when appropriately treated. It can be more complicated to treat when prosthetic material is present, often necessitating surgical revision as well as antimicrobial therapy. Endocarditis caused by gram-negative bacilli is a rare occurrence, with some literature and expert opinion suggesting superior outcomes with combined surgery and antibiotics when a prosthetic valve is involved. In cases where the prosthetic valve is well-functioning and undamaged, or cardiothoracic surgery represents a significant operative risk, it can be unclear how best to proceed. This report documents a case of Salmonella enterica subspecies enterica serovar enteritidis endocarditis of a mechanical mitral valve. The patient was managed with 6 weeks of intravenous antibiotics followed by suppressive oral antibiotic therapy. They remain in good health at 24 months.

Antibiotic treatment regimens for bone infection after debridement: a study of 902 cases

2020 ◽  
Author(s):  
Xiaohua Wang(Former Corresponding Author) ◽  
Li Fang ◽  
Yueqi Chen ◽  
Shulin Wang ◽  
Huan Ma ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Antibiotic Treatment ◽  
Bone Infection ◽  
Oral Antibiotic ◽  
Oral Antibiotics ◽  
Treatment Regimens ◽  
Intravenous Antibiotics ◽  
Abnormal Rate ◽  
Oral Group ◽  
Liver And Kidney

Abstract Purpose: Our aim was to investigate the clinical efficacy and complications of antibiotics treatment duration for the patients of bone infection. Methods: We retrospectively analyzed the patients with bone infection admitted to our hospital between March 2013 and October 2018. The surgical debridement was performed and the patients were divided into three groups: IV group (Intravenous antibiotics for 2 weeks); Oral group (Intravenous antibiotics for 2 weeks followed by oral antibiotics for 4 weeks); Rifampicin group (Intravenous antibiotics for 2 weeks followed by oral antibiotics plus rifampicin for 4 weeks). The infection control rate and complications were compared. Results ： A total of 902 patients were enrolled, the infection sites included 509 tibias, 228 femurs, 32 humeri, 23 radii and ulnae, 40 calcanei, 23 multiple-site infections and the other sites 47 cases. After at least 6 months of follow-up, 148 (16.4%) patients had recurrence of infection. The recurrence rate of IV group was 17.9%, which was no significant higher than that of Oral group (10.1%) or Rifampicin group (10.5%). The abnormal rate of Glutamic-pyruvic transaminase(ALT) in IV group was 15.1%, which was lower than that of Oral group (18.0%) and Rifampicin group (27.4%), P=0.026. The positive rates of proteinuria in the three groups were 3.2%, 4.5%, and 9.3%, respectively, P=0.020. Conclusion: After debridement of bone infection, the additional oral antibiotic treatment may increase the damage of liver and kidney, and can not significantly reduce the infection recurrence rate. Therefore, it is recommended to adopt short-term systemic antibiotic treatment after debridement.

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