Julie Gray, Russell J Benefield, Chanah K Gallagher, Heather Cummins, Laura K Certain
{"title":"\"再来一次,有感觉\":在美国一家医疗中心的倾向得分匹配队列中,骨科感染患者出院时口服抗生素与静脉注射抗生素的疗效无差异。","authors":"Julie Gray, Russell J Benefield, Chanah K Gallagher, Heather Cummins, Laura K Certain","doi":"10.1017/ash.2024.57","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To compare outcomes between patients discharged on intravenous (IV) versus oral (PO) antibiotics for the treatment of orthopedic infections, after creation of an IV-to-PO guideline, at a single academic medical center in the United States.</p><p><strong>Methods: </strong>This was a retrospective, propensity score matched, cohort study of adult patients hospitalized for orthopedic infections from September 30, 2020, to April 30, 2022. Patients discharged on PO antibiotics were matched to patients discharged on IV antibiotics. The primary outcome was one-year treatment failure following discharge. Secondary outcomes were incidence of 60-day treatment failure, adverse drug events (ADE), readmissions, infectious disease clinic \"no-show\" rates, and emergency department (ED) encounters.</p><p><strong>Results: </strong>Ninety PO-treated patients were matched to 90 IV-treated patients. Baseline characteristics were similar in the two groups after matching. There was no significant difference in the proportions of patients on PO versus IV antibiotics experiencing treatment failure at one year (26% vs 31%, <i>P</i> = .47). There were no significant differences for any secondary outcomes: treatment failure within 60 days (13% vs 14%, <i>P</i> = 1.00), ADE (13% vs 11%, <i>P</i> = .82), unplanned readmission (17% vs 21%, <i>P</i> = .57), or ED encounters (9% vs 18%, <i>P</i> = .54). Survival analyses identified no significant differences in time-to-event between PO and IV treatment for any of the outcomes assessed.</p><p><strong>Conclusions: </strong>There were no appreciable differences in outcomes between patients discharged on PO compared to IV regimens. Antimicrobial stewardship interventions to increase prescribing of PO antibiotics for the treatment of orthopedic infections should be encouraged.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11062794/pdf/","citationCount":"0","resultStr":"{\"title\":\"\\\"Once more, with feeling\\\": no difference in outcomes between patients discharged on oral versus intravenous antibiotics for orthopedic infections in a propensity score matched cohort at a US medical center.\",\"authors\":\"Julie Gray, Russell J Benefield, Chanah K Gallagher, Heather Cummins, Laura K Certain\",\"doi\":\"10.1017/ash.2024.57\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To compare outcomes between patients discharged on intravenous (IV) versus oral (PO) antibiotics for the treatment of orthopedic infections, after creation of an IV-to-PO guideline, at a single academic medical center in the United States.</p><p><strong>Methods: </strong>This was a retrospective, propensity score matched, cohort study of adult patients hospitalized for orthopedic infections from September 30, 2020, to April 30, 2022. Patients discharged on PO antibiotics were matched to patients discharged on IV antibiotics. The primary outcome was one-year treatment failure following discharge. Secondary outcomes were incidence of 60-day treatment failure, adverse drug events (ADE), readmissions, infectious disease clinic \\\"no-show\\\" rates, and emergency department (ED) encounters.</p><p><strong>Results: </strong>Ninety PO-treated patients were matched to 90 IV-treated patients. Baseline characteristics were similar in the two groups after matching. There was no significant difference in the proportions of patients on PO versus IV antibiotics experiencing treatment failure at one year (26% vs 31%, <i>P</i> = .47). There were no significant differences for any secondary outcomes: treatment failure within 60 days (13% vs 14%, <i>P</i> = 1.00), ADE (13% vs 11%, <i>P</i> = .82), unplanned readmission (17% vs 21%, <i>P</i> = .57), or ED encounters (9% vs 18%, <i>P</i> = .54). Survival analyses identified no significant differences in time-to-event between PO and IV treatment for any of the outcomes assessed.</p><p><strong>Conclusions: </strong>There were no appreciable differences in outcomes between patients discharged on PO compared to IV regimens. Antimicrobial stewardship interventions to increase prescribing of PO antibiotics for the treatment of orthopedic infections should be encouraged.</p>\",\"PeriodicalId\":72246,\"journal\":{\"name\":\"Antimicrobial stewardship & healthcare epidemiology : ASHE\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-04-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11062794/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Antimicrobial stewardship & healthcare epidemiology : ASHE\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1017/ash.2024.57\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Antimicrobial stewardship & healthcare epidemiology : ASHE","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1017/ash.2024.57","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的:比较一家学术医疗中心在制定静脉注射转口服抗生素指南后,采用静脉注射与口服抗生素治疗骨科感染的患者的疗效:比较美国一家学术医疗中心在制定静脉注射转口服抗生素指南后,使用静脉注射抗生素和口服抗生素治疗骨科感染的患者出院后的治疗效果:这是一项倾向得分匹配的回顾性队列研究,研究对象是 2020 年 9 月 30 日至 2022 年 4 月 30 日期间因骨科感染住院的成年患者。使用 PO 抗生素出院的患者与使用 IV 抗生素出院的患者相匹配。主要结果是出院后一年的治疗失败率。次要结果为 60 天治疗失败发生率、药物不良事件 (ADE)、再入院率、传染病诊所 "未就诊 "率和急诊科就诊率:90名接受过口服药物治疗的患者与90名接受过静脉注射治疗的患者进行了配对。配对后,两组患者的基线特征相似。使用 PO 抗生素和 IV 抗生素的患者在一年后治疗失败的比例没有明显差异(26% vs 31%,P = .47)。在以下次要结果中也无明显差异:60 天内治疗失败(13% vs 14%,P = 1.00)、ADE(13% vs 11%,P = .82)、非计划再入院(17% vs 21%,P = .57)或急诊就诊(9% vs 18%,P = .54)。生存分析表明,在任何一项评估结果中,口服和静脉注射治疗的事件发生时间均无显著差异:结论:与静脉注射疗法相比,采用口服药物出院的患者在治疗效果上没有明显差异。应鼓励采取抗菌药物管理干预措施,增加处方口服抗生素治疗骨科感染。
"Once more, with feeling": no difference in outcomes between patients discharged on oral versus intravenous antibiotics for orthopedic infections in a propensity score matched cohort at a US medical center.
Objective: To compare outcomes between patients discharged on intravenous (IV) versus oral (PO) antibiotics for the treatment of orthopedic infections, after creation of an IV-to-PO guideline, at a single academic medical center in the United States.
Methods: This was a retrospective, propensity score matched, cohort study of adult patients hospitalized for orthopedic infections from September 30, 2020, to April 30, 2022. Patients discharged on PO antibiotics were matched to patients discharged on IV antibiotics. The primary outcome was one-year treatment failure following discharge. Secondary outcomes were incidence of 60-day treatment failure, adverse drug events (ADE), readmissions, infectious disease clinic "no-show" rates, and emergency department (ED) encounters.
Results: Ninety PO-treated patients were matched to 90 IV-treated patients. Baseline characteristics were similar in the two groups after matching. There was no significant difference in the proportions of patients on PO versus IV antibiotics experiencing treatment failure at one year (26% vs 31%, P = .47). There were no significant differences for any secondary outcomes: treatment failure within 60 days (13% vs 14%, P = 1.00), ADE (13% vs 11%, P = .82), unplanned readmission (17% vs 21%, P = .57), or ED encounters (9% vs 18%, P = .54). Survival analyses identified no significant differences in time-to-event between PO and IV treatment for any of the outcomes assessed.
Conclusions: There were no appreciable differences in outcomes between patients discharged on PO compared to IV regimens. Antimicrobial stewardship interventions to increase prescribing of PO antibiotics for the treatment of orthopedic infections should be encouraged.