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Published in: BMC Infectious Diseases 1/2019

Open Access 01-12-2019 | Septicemia | Research article

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

Authors: Juliano Gasparetto, Felipe Francisco Tuon, Dayana dos Santos Oliveira, Tiago Zequinao, Gabriel Rammert Pipolo, Gabriel Velloso Ribeiro, Paola Delai Benincá, June Alisson Westarb Cruz, Thyago Proenca Moraes

Published in: BMC Infectious Diseases | Issue 1/2019

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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.
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Literature
1.
go back to reference Okumura LM, Silva MM, Veroneze I. Effects of a bundled antimicrobial stewardship program on mortality: a cohort study. Braz J Infect Dis. 2015;19:246–52.CrossRef Okumura LM, Silva MM, Veroneze I. Effects of a bundled antimicrobial stewardship program on mortality: a cohort study. Braz J Infect Dis. 2015;19:246–52.CrossRef
2.
go back to reference Waagsbo B, Sundoy A, Paulsen EQ. Reduction of unnecessary i.v. antibiotic days using general criteria for antibiotic switch. Scand J Infect Dis. 2008;40:468–73.CrossRef Waagsbo B, Sundoy A, Paulsen EQ. Reduction of unnecessary i.v. antibiotic days using general criteria for antibiotic switch. Scand J Infect Dis. 2008;40:468–73.CrossRef
3.
go back to reference Nathwani D, Lawson W, Dryden M, et al. Implementing criteria-based early switch/early discharge programmes: a European perspective. Clin Microbiol Infect. 2015;21(Suppl 2):S47–55.CrossRef Nathwani D, Lawson W, Dryden M, et al. Implementing criteria-based early switch/early discharge programmes: a European perspective. Clin Microbiol Infect. 2015;21(Suppl 2):S47–55.CrossRef
4.
go back to reference Beique L, Zvonar R. Addressing concerns about changing the route of antimicrobial administration from intravenous to oral in adult inpatients. Can J Hosp Pharm. 2015;68:318–26.PubMedPubMedCentral Beique L, Zvonar R. Addressing concerns about changing the route of antimicrobial administration from intravenous to oral in adult inpatients. Can J Hosp Pharm. 2015;68:318–26.PubMedPubMedCentral
5.
go back to reference Rebuck JA, Fish DN, Abraham E. Pharmacokinetics of intravenous and oral levofloxacin in critically ill adults in a medical intensive care unit. Pharmacotherapy. 2002;22:1216–25.CrossRef Rebuck JA, Fish DN, Abraham E. Pharmacokinetics of intravenous and oral levofloxacin in critically ill adults in a medical intensive care unit. Pharmacotherapy. 2002;22:1216–25.CrossRef
6.
go back to reference Cyriac JM, James E. Switch over from intravenous to oral therapy: a concise overview. J Pharmacol Pharmacother. 2014;5:83–7.CrossRef Cyriac JM, James E. Switch over from intravenous to oral therapy: a concise overview. J Pharmacol Pharmacother. 2014;5:83–7.CrossRef
7.
go back to reference Fischmann AM. BRASINDICE: Editora Andrei; 2018. Fischmann AM. BRASINDICE: Editora Andrei; 2018.
8.
go back to reference Tuon FF, Gasparetto J, Wollmann LC, Moraes TP. Mobile health application to assist doctors in antibiotic prescription - an approach for antibiotic stewardship. Braz J Infect Dis. 2017;21:660–4.CrossRef Tuon FF, Gasparetto J, Wollmann LC, Moraes TP. Mobile health application to assist doctors in antibiotic prescription - an approach for antibiotic stewardship. Braz J Infect Dis. 2017;21:660–4.CrossRef
9.
go back to reference Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63:e61–e111.CrossRef Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63:e61–e111.CrossRef
10.
go back to reference Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52:e103–20.CrossRef Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52:e103–20.CrossRef
11.
go back to reference Sawyer RG, Claridge JA, Nathens AB, et al. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med. 2015;372:1996–2005.CrossRef Sawyer RG, Claridge JA, Nathens AB, et al. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med. 2015;372:1996–2005.CrossRef
12.
go back to reference Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:801–10.CrossRef Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:801–10.CrossRef
13.
go back to reference Schneider A, Ostermann M. The AKI glossary. Intensive Care Med. 2017;43:893–7.CrossRef Schneider A, Ostermann M. The AKI glossary. Intensive Care Med. 2017;43:893–7.CrossRef
14.
go back to reference You J. Antimicrobial stewardship programs - cost-minimizing or cost-effective? Expert Opin Pharmacother. 2015;16:155–7.CrossRef You J. Antimicrobial stewardship programs - cost-minimizing or cost-effective? Expert Opin Pharmacother. 2015;16:155–7.CrossRef
15.
go back to reference Ruiz-Ramos J, Frasquet J, Roma E, et al. Cost-effectiveness analysis of implementing an antimicrobial stewardship program in critical care units. J Med Econ. 2017;20:652–9.CrossRef Ruiz-Ramos J, Frasquet J, Roma E, et al. Cost-effectiveness analysis of implementing an antimicrobial stewardship program in critical care units. J Med Econ. 2017;20:652–9.CrossRef
16.
go back to reference Sogayar AM, Machado FR, Rea-Neto A, et al. A multicentre, prospective study to evaluate costs of septic patients in Brazilian intensive care units. Pharmacoeconomics. 2008;26:425–34.CrossRef Sogayar AM, Machado FR, Rea-Neto A, et al. A multicentre, prospective study to evaluate costs of septic patients in Brazilian intensive care units. Pharmacoeconomics. 2008;26:425–34.CrossRef
17.
go back to reference Jackson A, Carberry M. The advance nurse practitioner in critical care: a workload evaluation. Nurs Crit Care. 2015;20:71–7.CrossRef Jackson A, Carberry M. The advance nurse practitioner in critical care: a workload evaluation. Nurs Crit Care. 2015;20:71–7.CrossRef
18.
go back to reference Biswal S, Mishra P, Malhotra S, Puri GD, Pandhi P. Drug utilization pattern in the intensive care unit of a tertiary care hospital. J Clin Pharmacol. 2006;46:945–51.CrossRef Biswal S, Mishra P, Malhotra S, Puri GD, Pandhi P. Drug utilization pattern in the intensive care unit of a tertiary care hospital. J Clin Pharmacol. 2006;46:945–51.CrossRef
19.
go back to reference Doernberg SB, Chambers HF. Antimicrobial stewardship approaches in the intensive care unit. Infect Dis Clin N Am. 2017;31:513–34.CrossRef Doernberg SB, Chambers HF. Antimicrobial stewardship approaches in the intensive care unit. Infect Dis Clin N Am. 2017;31:513–34.CrossRef
20.
go back to reference Schuts EC, Hulscher M, Mouton JW, et al. Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis. Lancet Infect Dis. 2016;16:847–56.CrossRef Schuts EC, Hulscher M, Mouton JW, et al. Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis. Lancet Infect Dis. 2016;16:847–56.CrossRef
21.
go back to reference Peixoto BC, Contrera GG, Cieslinski J, Gasparetto J, Tuon FF. Acute kidney injury in patients using low dose (3 mg/kg/day) of gentamicin under therapeutic dose monitoring. J Inf Secur. 2018;76:496–8. Peixoto BC, Contrera GG, Cieslinski J, Gasparetto J, Tuon FF. Acute kidney injury in patients using low dose (3 mg/kg/day) of gentamicin under therapeutic dose monitoring. J Inf Secur. 2018;76:496–8.
22.
go back to reference Tuon FF, Aragao BZ, Santos TA, Gasparetto J, Cordova K, Abujamra M. Acute kidney injury in patients using amikacin in an era of carbapenem-resistant bacteria. Infect Dis (Lond). 2016;48:3. Tuon FF, Aragao BZ, Santos TA, Gasparetto J, Cordova K, Abujamra M. Acute kidney injury in patients using amikacin in an era of carbapenem-resistant bacteria. Infect Dis (Lond). 2016;48:3.
23.
go back to reference Tuon FF, Romero R, Gasparetto J, Cieslinski J. Vancomycin trough level and loading dose. Infect Drug Resist. 2018;11:2393–6.CrossRef Tuon FF, Romero R, Gasparetto J, Cieslinski J. Vancomycin trough level and loading dose. Infect Drug Resist. 2018;11:2393–6.CrossRef
24.
go back to reference Tuon FF, Rocha JL, Gasparetto J. Polymyxin B and colistin-the economic burden of nephrotoxicity against multidrug resistant bacteria. J Med Econ. 2019;22:158–62.CrossRef Tuon FF, Rocha JL, Gasparetto J. Polymyxin B and colistin-the economic burden of nephrotoxicity against multidrug resistant bacteria. J Med Econ. 2019;22:158–62.CrossRef
25.
go back to reference Chin TW, Vandenbroucke A, Fong IW. Pharmacokinetics of trimethoprim-sulfamethoxazole in critically ill and non-critically ill AIDS patients. Antimicrob Agents Chemother. 1995;39:28–33.CrossRef Chin TW, Vandenbroucke A, Fong IW. Pharmacokinetics of trimethoprim-sulfamethoxazole in critically ill and non-critically ill AIDS patients. Antimicrob Agents Chemother. 1995;39:28–33.CrossRef
26.
go back to reference Gras-Le Guen C, Boscher C, Godon N, et al. Therapeutic amoxicillin levels achieved with oral administration in term neonates. Eur J Clin Pharmacol. 2007;63:657–62.CrossRef Gras-Le Guen C, Boscher C, Godon N, et al. Therapeutic amoxicillin levels achieved with oral administration in term neonates. Eur J Clin Pharmacol. 2007;63:657–62.CrossRef
27.
go back to reference Carlier M, Noe M, De Waele JJ, et al. Population pharmacokinetics and dosing simulations of amoxicillin/clavulanic acid in critically ill patients. J Antimicrob Chemother. 2013;68:2600–8.CrossRef Carlier M, Noe M, De Waele JJ, et al. Population pharmacokinetics and dosing simulations of amoxicillin/clavulanic acid in critically ill patients. J Antimicrob Chemother. 2013;68:2600–8.CrossRef
28.
go back to reference Solomkin JS, Reinhart HH, Dellinger EP, et al. Results of a randomized trial comparing sequential intravenous/oral treatment with ciprofloxacin plus metronidazole to imipenem/cilastatin for intra-abdominal infections. The Intra-Abdominal Infection Study Group. Ann Surg. 1996;223:303–15.CrossRef Solomkin JS, Reinhart HH, Dellinger EP, et al. Results of a randomized trial comparing sequential intravenous/oral treatment with ciprofloxacin plus metronidazole to imipenem/cilastatin for intra-abdominal infections. The Intra-Abdominal Infection Study Group. Ann Surg. 1996;223:303–15.CrossRef
29.
go back to reference Boyles TH, Whitelaw A, Bamford C, et al. Antibiotic stewardship ward rounds and a dedicated prescription chart reduce antibiotic consumption and pharmacy costs without affecting inpatient mortality or re-admission rates. PLoS One. 2013;8:e79747.CrossRef Boyles TH, Whitelaw A, Bamford C, et al. Antibiotic stewardship ward rounds and a dedicated prescription chart reduce antibiotic consumption and pharmacy costs without affecting inpatient mortality or re-admission rates. PLoS One. 2013;8:e79747.CrossRef
Metadata
Title
Intravenous-to-oral antibiotic switch therapy: a cross-sectional study in critical care units
Authors
Juliano Gasparetto
Felipe Francisco Tuon
Dayana dos Santos Oliveira
Tiago Zequinao
Gabriel Rammert Pipolo
Gabriel Velloso Ribeiro
Paola Delai Benincá
June Alisson Westarb Cruz
Thyago Proenca Moraes
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2019
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-019-4280-0

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