title: Effectiveness of sequential intravenous-to-oral antibiotic switch therapy in hospitalized patients with gram-positive infection: the SEQUENCE cohort study.
abstract: Switching from intravenous to oral antibiotic therapy may improve inpatient management and reduce hospital stays and the complications of intravenous treatment. We aimed to assess the effectiveness of intravenous-to-oral antibiotic switch therapy and an early discharge algorithm in hospitalized patients with gram-positive infection. We performed a prospective cohort study with a retrospective comparison cohort, recruited from eight tertiary, acute-care Spanish referral hospitals. All patients included had culture-confirmed methicillin-resistant gram-positive infection, or methicillin-susceptible gram-positive infection and beta-lactam allergy and had received intravenous treatment with glycopeptides, lipopeptides, or linezolid. The study comprised two cohorts: the prospective cohort to assess the effectiveness of a sequential intravenous-to-oral antibiotic switch algorithm and early discharge, and a retrospective cohort in which the algorithm had not been applied, used as the comparator. A total of 247 evaluable patients were included; 115 in the prospective and 132 in the retrospective cohort. Forty-five retrospective patients (34 %) were not changed to oral antibiotics, and 87 (66 %) were changed to oral antibiotics without following the proposed algorithm. The duration of hospitalization was significantly shorter in the prospective cohort compared to the retrospective group that did not switch to oral drugs (16.7 ± 18.7 vs 23 ± 13.4 days, P  < 0.001). No differences were observed regarding the incidence of catheter-related bacteraemia (4.4 % vs 2.6 %, P = 0.621). Our results suggest that an intravenous-to-oral antibiotic switch strategy is effective for reducing the length of hospital stay in selected hospitalized patients with gram-positive infection.
authors.affiliation: Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. dolorodriguez@vhebron.net.
authors.forename: D
authors.initials: D
authors.lastname: Rodriguez-Pardo
authors.affiliation: Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. cpigrau@vhebron.net.
authors.forename: C
authors.initials: C
authors.lastname: Pigrau
authors.affiliation: Pharmacy Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Campany
authors.affiliation: Department of Internal Medicine, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Diaz-Brito
authors.affiliation: Department of Infectious Diseases, Hosp. Clínic i Provincial, IDIBAPS, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Morata
authors.affiliation: Department of Infectious Diseases, Hospital Universitari Arnau de Vilanova, Lleida, Spain.
authors.forename: I C
authors.initials: IC
authors.lastname: de Diego
authors.affiliation: Department of Infectious Diseases, Hospital del Mar, IMIM, CEXS-UPF, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Sorlí
authors.affiliation: Department of Internal Medicine, Hospital Universitari Sant Joan de Reus, Reus, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Iftimie
authors.affiliation: Department of Internal Medicine, Fundació Althaia, Hospital de Sant Joan de Déu, Manresa, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Pérez-Vidal
authors.affiliation: Department of Internal Medicine, Hospìtal Universitari Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain.
authors.forename: G
authors.initials: G
authors.lastname: García-Pardo
authors.affiliation: Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: T
authors.initials: T
authors.lastname: Larrainzar-Coghen
authors.affiliation: Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Almirante
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D013030:Spain; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents