The Clinical Benefit of In-Hospital Observation in ‘Low-risk’ Pneumonia Patients After Conversion From Parenteral to Oral Antimicrobial Therapy

Rhew, David C.; Hackner, Dani; Henderson, L; Ellrodt, A. Gray; Weingarten, Scott

doi:10.1378/chest.113.1.142

Cited by 52 publications

(29 citation statements)

References 17 publications

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“…Over 40% of patients with CURB-65 scores of 0, 1 and 2 stayed in the hospital for f3 days. The mean duration of intravenous therapy and hospital stay in the current study was consistent with that in studies published elsewhere [22,23].…”

supporting

confidence: 91%

Validation of a predictive rule for the management of community-acquired pneumonia

Capelastegui

España²,

Quintana³

et al. 2006

Eur Respir J

326

213

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The CURB-65 score (Confusion, Urea .7 mmol?L -1 , Respiratory rate o30?min, low Blood pressure, and age o65 yrs) has been proposed as a tool for augmenting clinical judgement for stratifying patients with community-acquired pneumonia (CAP) into different management groups.The six-point CURB-65 score was retrospectively applied in a prospective, consecutive cohort of adult patients with a diagnosis of CAP seen in the emergency department of a 400-bed teaching hospital from March 1, 2000 to February 29, 2004. A total of 1,100 inpatients and 676 outpatients were included.The 30-day mortality rate in the entire cohort increased directly with increasing CURB-65 score: 0, 1.1, 7.6, 21, 41.9 and 60% for CURB-65 scores of 0, 1, 2, 3, 4, and 5, respectively. The score was also significantly associated with the need for mechanical ventilation and rate of hospital admission in the entire cohort, and with duration of hospital stay among inpatients.The CURB-65 score (Confusion, Urea .7 mmol?L -1, Respiratory rate o30?min, low Blood pressure, and age o65 yrs), and a simpler CRB-65 score that omits the blood urea measurement, helps classify patients with community-acquired pneumonia into different groups according to the mortality risk and significantly correlates with community-acquired pneumonia management key points. The new score can also be used as a severity adjustment measure.

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supporting

confidence: 91%

Validation of a predictive rule for the management of community-acquired pneumonia

Capelastegui

España²,

Quintana³

et al. 2006

Eur Respir J

326

213

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“…In fact, no re-admissions occurred among the patients with appropriate hospital stay, so that in the absence of problems, the fixed targets of 5 and 7 days depending on the severity of illness are safe. WEINGARTEN and coworkers [13,23,24] investigated the safety and effectiveness of a practice guideline that provided information about switching patients from parenteral to oral antimicrobials and early hospital discharge. They found a high compliance and that patient outcomes remained unchanged [13,23,24].…”

Section: Discussionmentioning

confidence: 99%

“…WEINGARTEN and coworkers [13,23,24] investigated the safety and effectiveness of a practice guideline that provided information about switching patients from parenteral to oral antimicrobials and early hospital discharge. They found a high compliance and that patient outcomes remained unchanged [13,23,24]. In the multicentre study of MCCORMICK et al [18], medical outcomes including mortality, hospital re-admission rate, and dates of return to usual activities and to work were similar in patients admitted to hospital with differences in the length of stay.…”

Section: Discussionmentioning

confidence: 99%

Initial risk class and length of hospital stay in community-acquired pneumonia

et al. 2001

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Initial risk class and length of hospital stay in community-acquired pneumonia. R. Menéndez, D. Ferrando, J.M. Vallés, E. Martínez, M. Perpiñá. #ERS Journals Ltd 2001. ABSTRACT: The total medical costs of community-acquired pneumonia are directly related to the costs of hospital admission and length of stay. The aim of the present study was to evaluate the reasons for prolonged duration of stay in patients stratified in five risk classes for death, and to identify factors associated with prolonged stay.The study population consisted of 295 patients. According to lower (classes I, II, III) or to higher (classes IV, V) risk, the target duration of hospitalization was set at 5 and 7 days, respectively. The causes of prolonged hospitalization were classified as pneumonia-related, complications, unstable comorbid diseases and nonclinical factors.The overall percentage of patients with appropriate duration of hospitalization was 32%. Causes of prolonged hospitalization were related mainly to pneumonia (32%) from all risk classes. Morbid complications and instability of the underlying illness were greater in class V patients. Nonclinical factors were present in 29.5% of cases. Hypoxaemia, anaemia, hypoalbuminaemia, and complications appearing before 72 h were associated with prolonged hospitalization.The cause of prolonged hospitalization of patients with community-acquired pneumonia is multifactorial, depending mainly on pneumonia and comorbid conditions but there is a large number of unnecessary hospitalization days that could be reduced by improving the efficiency of hospital care. Eur Respir J 2001; 18: 151-156.

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“…Once stability was achieved, significant clinical deterioration occurred in less than 1% of patients. Although the practice of observing patients in the hospital after switching from parenteral to oral therapy is commonplace, Rhew et al [26] found that among low-risk patients with CAP, this practice was not associated with significant clinical benefit and elimination of the practice would reduce length of stay and costs.…”

Section: Antimicrobial Therapymentioning

confidence: 99%

Community-acquired pneumonia: An overview

Kanno

Brown

1999

Curr Infect Dis Rep

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Community-acquired pneumonia (CAP) accounts for a significant number of hospitalizations and outpatient visits, as well as substantial health care expenditures. CAP is particularly common among the elderly who account for more than 90% of deaths due to pneumonia. Streptococcus pneumoniae is believed to be the most common microbial etiology of CAP, but recent studies suggest that the atypical pathogens may be more common than previously thought, particularly among ambulatory patients. Recent studies have provided data regarding risk of mortality and process of care and outcomes. Increasing resistance among strains of S. pneumoniae has impacted the approach to the empiric therapy of CAP. The Infectious Diseases Society of America published guidelines for the evaluation and management of CAP this past year. Pathogen-specific therapy guided by the results of sputum gram stain and culture is emphasized. Despite enthusiasm for practice guidelines and clinical pathways, there remains insufficient published data to determine their impact on quality and cost of care in patients with CAP.

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The Clinical Benefit of In-Hospital Observation in ‘Low-risk’ Pneumonia Patients After Conversion From Parenteral to Oral Antimicrobial Therapy

Cited by 52 publications

References 17 publications

Validation of a predictive rule for the management of community-acquired pneumonia

Validation of a predictive rule for the management of community-acquired pneumonia

Initial risk class and length of hospital stay in community-acquired pneumonia

Community-acquired pneumonia: An overview

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