Intravenous-to-oral antibiotic switch therapy: a cross-sectional study in critical care units

Abstract

Background This study aimed to evaluate the oral switch (OS) stewardship intervention in the intensive care unit (ICU). Methods This was a retrospective study with a convenience sample in two Brazilian ICUs from different hospitals in patients with sepsis receiving antibiotic therapy. The stewardship intervention included OS in patients diagnosed with sepsis when clinical stability was achieved. The primary outcome was overall mortality. Other variables evaluated were as follows: cost of antimicrobial treatment, daily costs of intensive care, acute kidney injury, and length of stay. Results There was no difference in mortality between the OS and non-OS groups ( p = 0.06). Length of stay in the ICU ( p = 0.029) was shorter and acute kidney injury incidence ( p = 0.032) and costs of antimicrobial therapy ( p < 0.001) were lower in the OS group. Conclusion OS stewardship programs in the ICU may be considered a safe strategy. Switch therapy reduced the cost and shortened the length of stay in ICUs. Electronic supplementary material The online version of this article (10.1186/s12879-019-4280-0) contains supplementary material, which is available to authorized users.

Impact of the Audit and Intervention of Infectologists in the Use of Antimicrobials in Intensive Care Units

“…These ndings re ect the main diagnostic indications observed in this study, which referred to respiratory infections and septic shock. This data corroborates with several studies that point out the respiratory system as the most affected in ICUs [3,2,12,4]. When comparing the data from this study with others, it was found that the rate regarding the time spent using carbapenems was higher than the ndings by De Bus L et al [3] (236 DOT / 1000pd) and…”

“…Similar data were observed by Rupali P et al [7] in which in the preintervention phase mortality was 22.4% and in the intervention phase 27.6%. Higher percentages were found by Marcelino FAB [2] (33.0%) and lower ones as described by De Bus L et al [3] (10.7%), Gasparetto J et al [12] (12.6%), and Álvarez-Lerma F et al [11], this reports that in the previous year the intervention the mortality percentage was 13.7% and in the following year after the intervention is reduced to 11.1%.…”

“…The most prescribed antimicrobial classes, individually in units with global re ex, were related to carbapenems, followed by glycopeptides. In addition to those described, studies also show signi cant values for cephalosporin and beta-lactam prescriptions (piperacillin + tazobactam) in intensive care units [2,1,8,12]. The data reveal that the most recurrent antimicrobial therapy involves agents of a broad spectrum and that it is often performed empirically, during the uncertainty of the diagnosis, not always representing the appropriate therapy [2,4].…”

Impact of Prescriptionauditing&nbsp;and Intervention of Infectious Diseases Specialist on The Use of Antimicrobials in Intensive Care Units

“…In addition to the antimicrobials described, studies still show expressive values of cephalosporin prescriptions in intensive care units [1-3, 6-8, 12]. These ndings corroborate with several studies that point out respiratory infections, followed by urinary infections, which explains the emphasis on cephalosporins, as the main predictors for the use of antimicrobials in ICUs [2][3][4]12].…”

Optimizing the Use of Antibiotic Agents in the Pediatric Intensive Care Unit: A Narrative Review

“…However, for a large group of antibiotics it is proven that, if the circumstances are right, essentially the same amount of drug is found in the blood when given intravenously or orally [152]. The few studies that have investigated the bioequivalence, efficacy, and safety of an early IV-to-PO antibiotic switch in eligible adults ICU patients demonstrated a shorter ICU LOS, no increase in mortality, and lower costs of antibiotic therapy [153]. Nevertheless, we should remain cautious in critically ill patients, as was illustrated by anecdotal PK data on IV-to-PO switch of moxifloxacin in an adult ICU [154].…”