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Early Discharge of Infected Patients Through Appropriate Antibiotic Use
Lawrence J. Eron, MD;
Stacey Passos
Arch Intern Med. 2001;161:61-65.
Background Patients with infections are usually discharged from the hospital with
antibiotics when afebrile and clinically improved.
Objectives To compare outcomes of early vs conventionally discharged patients and
to examine the role of antibiotic use in the discharge process.
Methods One hundred eleven patients hospitalized with cellulitis, community-acquired
pneumonia, or pyelonephritis (urinary tract infection) discharged from the
hospital early in their clinical course before defervescence by an infectious
diseases hospitalist (L.J.E.) were compared in a case-controlled study with
112 patients discharged from the hospital according to conventional standards
of care by internal medicine (IM) hospitalists. Patients were matched for
age, sex, diagnosis, and comorbidities. Outcomes were determined for average
lengths of stay, readmission to the hospital within 30 days with the same
diagnosis, satisfaction with their discharge program, and time to return to
their normal activities of daily living.
Results Patients cared for by the infectious diseases hospitalist had a shorter
average length of stay (mean difference, 1.7 days), no readmissions, higher
satisfaction scores, and a shorter time to return to their activities of daily
living, compared with those cared for by the IM hospitalists. Analysis of
the antibiotics that patients were discharged with revealed that the infectious
diseases hospitalist used outpatient parenteral antibiotic therapy more frequently
than IM hospitalists in the treatment of cellulitis, and switched from intravenous
to oral antibiotics sooner than IM hospitalists for patients with community-acquired
pneumonia and urinary tract infection.
Conclusions The infectious diseases hospitalist discharged patients from the hospital
earlier than the IM hospitalists by more efficient use of antibiotics. The
earlier discharge did not adversely affect outcomes.
From the Division of Inpatient Medicine, Department of Medicine, Kaiser
Permanente Medical Center (Dr Eron and Ms Passos), and the John A. Burns School
of Medicine, University of Hawaii (Dr Eron), Honolulu, Hawaii.
Reprints: Lawrence J. Eron, MD, 3288 Moanalua Rd, Honolulu, HI 96819
(e-mail: Lawrence.Eron{at}kp.org).
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