title: Risk factors for requiring intravenous antibiotic therapy in hospital and 30-day readmission for exacerbations of bronchiectasis.
abstract: BACKGROUND
  The safety and efficacy of domiciliary intravenous (IV) antibiotic therapy compared to inpatient hospital treatment for exacerbations of bronchiectasis has been established. Factors that determine the setting for IV antibiotic therapy need to be characterized further.
  
  
  OBJECTIVE
  We aimed to identify factors at presentation that were associated with the requirement for IV antibiotic therapy delivered in hospital and 30-day readmission.
  
  
  METHODS
  Retrospective cohort study of all IV antibiotic courses administered to patients with bronchiectasis by a specialist respiratory unit over a 2-year period.
  
  
  METHODS
  We assessed demographic data, treatment outcomes, morbidity, mortality, and 30-day readmission rates. Multiple linear regression analysis was performed to identify factors associated with inpatient IV antibiotics and 30-day readmission.
  
  
  RESULTS
  One hundred six patients received 243 courses of IV antibiotic therapy in 2 years. Sixty-six cases (27.2%) were managed in hospital, 28 cases (11.5%) required initial admission prior to early supported discharge to complete IV antibiotics at home and 149 cases (61.3%) received domiciliary IV antibiotics. Bronchiectasis Severity Index (P < 0.0001) and emergency presentation with an exacerbation (P < 0.0001) were independent factors associated with the requirement for inpatient IV antibiotic therapy. There were no differences between mortality (P = 0.06) and morbidity (P = 0.1) between groups. Thirty-day readmission following early supported discharge was higher compared to inpatient or domiciliary therapy (P=0.0004).
  
  
  CONCLUSIONS
  A higher Bronchiectasis Severity Index and emergency presentation with an exacerbation are independently associated with the need for IV antibiotics delivered in hospital. We could not identify any factors that predicted 30-day readmission in a multi-variable model.
authors.affiliation: From the Department of Respiratory Medicine, Royal Infirmary of Edinburgh, 51 Little Frances Crescent, Edinburgh EH16 4SA, UK prasad.velu@nhslothian.scot.nhs.uk.
authors.forename: P P
authors.initials: PP
authors.lastname: Velu
authors.affiliation: MRC Centre for Inflammation Research, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.
authors.forename: P
authors.initials: P
authors.lastname: Bedi
authors.affiliation: From the Department of Respiratory Medicine, Royal Infirmary of Edinburgh, 51 Little Frances Crescent, Edinburgh EH16 4SA, UK.
authors.forename: K
authors.initials: K
authors.lastname: Turnbull
authors.affiliation: From the Department of Respiratory Medicine, Royal Infirmary of Edinburgh, 51 Little Frances Crescent, Edinburgh EH16 4SA, UK.|MRC Centre for Inflammation Research, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.
authors.forename: A T
authors.initials: AT
authors.lastname: Hill
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001987:Bronchiectasis / Q000188:drug therapy* / Q000503:physiopathology; D004630:Emergencies; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D018575:Home Care Services, Hospital-Based; D006760:Hospitalization; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012606:Scotland; D012646:Self Administration; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents