Treatment Pathway Shortens Length of Stay for Pneumonia

WASHINGTON — A clinical pathway involving early mobilization and an early switch from intravenous to oral antibiotics reduced the length of stay for patients with community-acquired pneumonia by more than 2 days, in a randomized study of 401 patients.

The median length of stay was significantly shorter for patients randomized to the clinical pathway, compared with those randomized to standard care—95 hours vs. 150 hours, Dr. Jordi Carratalà said at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

The use of the clinical pathway “was effective in reducing the duration of intravenous antibiotic therapy and length of stay without compromising patient outcomes,” said Dr. Carratalà of the infectious disease service at the Hospital Universitari de Bellvitge, Barcelona.

The first step of the clinical pathway was early mobilization. This involved getting the patient walking or at least sitting up for at least 20 minutes during the first 24 hours of hospitalization, with progressive periods of walking/sitting on successive days.

Then patients were switched from intravenous to oral antibiotics based on objective criteria. They were switched to oral antibiotics when they had a temperature no greater than 100° F (at two measurements at least 3 hours apart), showed improvement or resolution of symptoms, were able to maintain oral intake, and were hemodynamically stable; any comorbid conditions also had to be stable.

After patients were mobilized, on oral antibiotics, and stable, they were discharged.

A total of 401 immunocompetent adults diagnosed with community-acquired pneumonia (CAP) were randomized: 200 to conventional treatment and 201 to the clinical pathway. Patients with shock, aspiration pneumonia, or empyema were excluded. The patients in the two groups were similar in terms of demographic and baseline characteristics.

Streptococcus pneumoniae was the most commonly identified organism in both groups (85 patients in the intervention group and 79 in the control group). The causative organism was unknown in many cases in both groups as well (85 patients in the intervention group and 92 patients in the control group). Other identified organisms included Haemophilus influenzae and Legionella pneumophila.

The median duration of intravenous antibiotic therapy was also significantly shorter in the intervention group, compared with the controls (48 hours vs. 96 hours). A significantly lower percentage of the intervention group had adverse drug reactions, compared with the controls (4.5% vs. 16%). There were no differences between the two groups in terms of readmission rates or overall mortality.

“Switching from intravenous to oral therapy as soon as patients are clinically stable can reduce length of stay and lower the associated costs,” Dr. Carratalà said. However, the length of intravenous antibiotic use for the treatment of CAP varies widely, which prompted the researchers to undertake the trial.

WASHINGTON — A clinical pathway involving early mobilization and an early switch from intravenous to oral antibiotics reduced the length of stay for patients with community-acquired pneumonia by more than 2 days, in a randomized study of 401 patients.

The median length of stay was significantly shorter for patients randomized to the clinical pathway, compared with those randomized to standard care—95 hours vs. 150 hours, Dr. Jordi Carratalà said at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

The use of the clinical pathway “was effective in reducing the duration of intravenous antibiotic therapy and length of stay without compromising patient outcomes,” said Dr. Carratalà of the infectious disease service at the Hospital Universitari de Bellvitge, Barcelona.

The first step of the clinical pathway was early mobilization. This involved getting the patient walking or at least sitting up for at least 20 minutes during the first 24 hours of hospitalization, with progressive periods of walking/sitting on successive days.

Then patients were switched from intravenous to oral antibiotics based on objective criteria. They were switched to oral antibiotics when they had a temperature no greater than 100° F (at two measurements at least 3 hours apart), showed improvement or resolution of symptoms, were able to maintain oral intake, and were hemodynamically stable; any comorbid conditions also had to be stable.

After patients were mobilized, on oral antibiotics, and stable, they were discharged.

A total of 401 immunocompetent adults diagnosed with community-acquired pneumonia (CAP) were randomized: 200 to conventional treatment and 201 to the clinical pathway. Patients with shock, aspiration pneumonia, or empyema were excluded. The patients in the two groups were similar in terms of demographic and baseline characteristics.

Streptococcus pneumoniae was the most commonly identified organism in both groups (85 patients in the intervention group and 79 in the control group). The causative organism was unknown in many cases in both groups as well (85 patients in the intervention group and 92 patients in the control group). Other identified organisms included Haemophilus influenzae and Legionella pneumophila.

The median duration of intravenous antibiotic therapy was also significantly shorter in the intervention group, compared with the controls (48 hours vs. 96 hours). A significantly lower percentage of the intervention group had adverse drug reactions, compared with the controls (4.5% vs. 16%). There were no differences between the two groups in terms of readmission rates or overall mortality.

“Switching from intravenous to oral therapy as soon as patients are clinically stable can reduce length of stay and lower the associated costs,” Dr. Carratalà said. However, the length of intravenous antibiotic use for the treatment of CAP varies widely, which prompted the researchers to undertake the trial.

WASHINGTON — A clinical pathway involving early mobilization and an early switch from intravenous to oral antibiotics reduced the length of stay for patients with community-acquired pneumonia by more than 2 days, in a randomized study of 401 patients.

The median length of stay was significantly shorter for patients randomized to the clinical pathway, compared with those randomized to standard care—95 hours vs. 150 hours, Dr. Jordi Carratalà said at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

The use of the clinical pathway “was effective in reducing the duration of intravenous antibiotic therapy and length of stay without compromising patient outcomes,” said Dr. Carratalà of the infectious disease service at the Hospital Universitari de Bellvitge, Barcelona.

The first step of the clinical pathway was early mobilization. This involved getting the patient walking or at least sitting up for at least 20 minutes during the first 24 hours of hospitalization, with progressive periods of walking/sitting on successive days.

Then patients were switched from intravenous to oral antibiotics based on objective criteria. They were switched to oral antibiotics when they had a temperature no greater than 100° F (at two measurements at least 3 hours apart), showed improvement or resolution of symptoms, were able to maintain oral intake, and were hemodynamically stable; any comorbid conditions also had to be stable.

After patients were mobilized, on oral antibiotics, and stable, they were discharged.

A total of 401 immunocompetent adults diagnosed with community-acquired pneumonia (CAP) were randomized: 200 to conventional treatment and 201 to the clinical pathway. Patients with shock, aspiration pneumonia, or empyema were excluded. The patients in the two groups were similar in terms of demographic and baseline characteristics.

Streptococcus pneumoniae was the most commonly identified organism in both groups (85 patients in the intervention group and 79 in the control group). The causative organism was unknown in many cases in both groups as well (85 patients in the intervention group and 92 patients in the control group). Other identified organisms included Haemophilus influenzae and Legionella pneumophila.

The median duration of intravenous antibiotic therapy was also significantly shorter in the intervention group, compared with the controls (48 hours vs. 96 hours). A significantly lower percentage of the intervention group had adverse drug reactions, compared with the controls (4.5% vs. 16%). There were no differences between the two groups in terms of readmission rates or overall mortality.

“Switching from intravenous to oral therapy as soon as patients are clinically stable can reduce length of stay and lower the associated costs,” Dr. Carratalà said. However, the length of intravenous antibiotic use for the treatment of CAP varies widely, which prompted the researchers to undertake the trial.