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In-hospital observation after antibiotic switch in pneumonia: a national evaluation.
Am J Med. 2006 Jun; 119(6):512.e1-7.AJ

Abstract

PURPOSE

To evaluate the clinical benefit of in-hospital observation after the switch from intravenous (IV) to oral antibiotics in a large Medicare population. Retrospective studies of relatively small size indicate that the practice of in-hospital observation after the switch from IV to oral antibiotics for patients hospitalized with community-acquired pneumonia (CAP) is unnecessary.

METHODS

We performed a retrospective examination of the US Medicare National Pneumonia Project database. Eligible patients were discharged with an ICD-9-CM diagnosis consistent with community-acquired pneumonia and divided into 2 groups: 1) a "not observed" cohort, in which patients were discharged on the same day as the switch from IV to oral antibiotics and 2) an "observed for 1 day" cohort, in which patients remained hospitalized for 1 day after the switch from IV to oral antibiotics. We compared clinical outcomes between these 2 cohorts.

RESULTS

A total of 39,242 cases were sampled, representing 4341 hospitals in all 50 states and the District of Columbia. There were 5248 elderly patients who fulfilled eligibility criteria involving a length of stay of no more than 7 hospital days (2536 "not observed" and 2712 "observed for 1 day" patients). Mean length of stay was 3.8 days for the "not observed" cohort and 4.5 days for the "observed for 1 day" cohort (P <.0001). There was no significant difference in 14-day hospital readmission rate (7.8% in the "not observed" cohort vs 7.2% "observed for 1 day" cohort, odds ratio 0.91; 95% confidence interval [CI] 0.74-1.12; P =.367) and 30-day mortality rate (5.1% "not observed" cohort vs 4.4% in the "observed for 1 day" cohort, odds ratio 0.86; 95% CI, 0.67-1.11; P =.258) between the "not observed" and "observed for 1 day" cohorts.

CONCLUSIONS

Our analysis of the US Medicare Pneumonia Project database provides further evidence that the routine practice of in-hospital observation after the switch from IV to oral antibiotics for patients with CAP may be avoided in patients who are clinically stable although these findings should be verified in a large randomized controlled trial.

Authors+Show Affiliations

Division of Infectious Diseases, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, Calif, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Multicenter Study
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

16750965

Citation

Nathan, Ramesh V., et al. "In-hospital Observation After Antibiotic Switch in Pneumonia: a National Evaluation." The American Journal of Medicine, vol. 119, no. 6, 2006, pp. 512.e1-7.
Nathan RV, Rhew DC, Murray C, et al. In-hospital observation after antibiotic switch in pneumonia: a national evaluation. Am J Med. 2006;119(6):512.e1-7.
Nathan, R. V., Rhew, D. C., Murray, C., Bratzler, D. W., Houck, P. M., & Weingarten, S. R. (2006). In-hospital observation after antibiotic switch in pneumonia: a national evaluation. The American Journal of Medicine, 119(6), e1-7.
Nathan RV, et al. In-hospital Observation After Antibiotic Switch in Pneumonia: a National Evaluation. Am J Med. 2006;119(6):512.e1-7. PubMed PMID: 16750965.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - In-hospital observation after antibiotic switch in pneumonia: a national evaluation. AU - Nathan,Ramesh V, AU - Rhew,David C, AU - Murray,Cynthia, AU - Bratzler,Dale W, AU - Houck,Peter M, AU - Weingarten,Scott R, PY - 2005/07/07/received PY - 2005/09/07/revised PY - 2005/09/08/accepted PY - 2006/6/6/pubmed PY - 2006/6/10/medline PY - 2006/6/6/entrez SP - 512.e1 EP - 7 JF - The American journal of medicine JO - Am J Med VL - 119 IS - 6 N2 - PURPOSE: To evaluate the clinical benefit of in-hospital observation after the switch from intravenous (IV) to oral antibiotics in a large Medicare population. Retrospective studies of relatively small size indicate that the practice of in-hospital observation after the switch from IV to oral antibiotics for patients hospitalized with community-acquired pneumonia (CAP) is unnecessary. METHODS: We performed a retrospective examination of the US Medicare National Pneumonia Project database. Eligible patients were discharged with an ICD-9-CM diagnosis consistent with community-acquired pneumonia and divided into 2 groups: 1) a "not observed" cohort, in which patients were discharged on the same day as the switch from IV to oral antibiotics and 2) an "observed for 1 day" cohort, in which patients remained hospitalized for 1 day after the switch from IV to oral antibiotics. We compared clinical outcomes between these 2 cohorts. RESULTS: A total of 39,242 cases were sampled, representing 4341 hospitals in all 50 states and the District of Columbia. There were 5248 elderly patients who fulfilled eligibility criteria involving a length of stay of no more than 7 hospital days (2536 "not observed" and 2712 "observed for 1 day" patients). Mean length of stay was 3.8 days for the "not observed" cohort and 4.5 days for the "observed for 1 day" cohort (P <.0001). There was no significant difference in 14-day hospital readmission rate (7.8% in the "not observed" cohort vs 7.2% "observed for 1 day" cohort, odds ratio 0.91; 95% confidence interval [CI] 0.74-1.12; P =.367) and 30-day mortality rate (5.1% "not observed" cohort vs 4.4% in the "observed for 1 day" cohort, odds ratio 0.86; 95% CI, 0.67-1.11; P =.258) between the "not observed" and "observed for 1 day" cohorts. CONCLUSIONS: Our analysis of the US Medicare Pneumonia Project database provides further evidence that the routine practice of in-hospital observation after the switch from IV to oral antibiotics for patients with CAP may be avoided in patients who are clinically stable although these findings should be verified in a large randomized controlled trial. SN - 1555-7162 UR - https://www.unboundmedicine.com/medline/citation/16750965/In_hospital_observation_after_antibiotic_switch_in_pneumonia:_a_national_evaluation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9343(05)00807-7 DB - PRIME DP - Unbound Medicine ER -