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A prospective cohort study of the use of domiciliary intravenous antibiotics in bronchiectasis.

Bedi P, Sidhu MK, Donaldson LS, Chalmers JD, Smith MP, Turnbull K, Pentland JL, Scott J, Hill AT - NPJ Prim Care Respir Med (2014)

Bottom Line: There was significant clinical and quality of life improvement in all groups, with resolution of infection in 76% in the inpatient group, 80% in the ESD group and 80% in the domiciliary group.No mortality was recorded in either group.Total bed days saved was 1443.

View Article: PubMed Central - PubMed

Affiliation: Centre for Inflammation Research, Queen's Medical Research Institute, Edinburgh, UK.

ABSTRACT

Background: We introduced domiciliary intravenous (IV) antibiotic therapy in patients with bronchiectasis to promote patient-centred domiciliary treatment instead of hospital inpatient treatment.

Aim: To assess the efficacy and safety of domiciliary IV antibiotic therapy in patients with non-cystic fibrosis bronchiectasis.

Methods: In this prospective study conducted over 5 years, we assessed patients' eligibility for receiving domiciliary treatment. All patients received 14 days of IV antibiotic therapy and were monitored at baseline/day 7/day 14. We assessed the treatment outcome, morbidity, mortality and 30-day readmission rates.

Results: A total of 116 patients received 196 courses of IV antibiotics. Eighty courses were delivered as inpatient treatment, 32 as early supported discharge (ESD) and 84 as domiciliary therapy. There was significant clinical and quality of life improvement in all groups, with resolution of infection in 76% in the inpatient group, 80% in the ESD group and 80% in the domiciliary group. Morbidity was recorded in 13.8% in the inpatient group, 9.4% in the ESD group and 14.2% in the domiciliary IV group. No mortality was recorded in either group. Thirty-day readmission rates were 13.8% in the inpatient group, 12.5% in the ESD group and 14.2% in the domiciliary group. Total bed days saved was 1443.

Conclusion: Domiciliary IV antibiotic therapy in bronchiectasis is clinically effective and was safe in our cohort of patients.

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Related in: MedlinePlus

Flowchart showing initial assessment and recruitment of patients for domiciliary IV antibiotic therapy.
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fig1: Flowchart showing initial assessment and recruitment of patients for domiciliary IV antibiotic therapy.

Mentions: Patients were divided into three groups based on where the antibiotic courses were delivered—those who received IV inpatient antibiotic therapy for the 14 days, those who were allowed ESD, and those who received domiciliary IV antibiotic therapy for the 14 days. There were 80 patients who received inpatient treatment for 14 days, 32 had ESD and 84 received the full 14 days of domiciliary therapy (Figure 1). The total patient number represents the total number of antibiotic courses as one patient may have received more than one course of antibiotic. The median (interquartile range) duration of inpatient treatment in the ESD group was 8 days (7–11). In all, 74.3% needed IV antibiotics because of failure to respond to oral antibiotics, 10.2% had a pathogen requiring IV antibiotic therapy and 15.5% had severe exacerbations necessitating inpatient admission.


A prospective cohort study of the use of domiciliary intravenous antibiotics in bronchiectasis.

Bedi P, Sidhu MK, Donaldson LS, Chalmers JD, Smith MP, Turnbull K, Pentland JL, Scott J, Hill AT - NPJ Prim Care Respir Med (2014)

Flowchart showing initial assessment and recruitment of patients for domiciliary IV antibiotic therapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4373503&req=5

fig1: Flowchart showing initial assessment and recruitment of patients for domiciliary IV antibiotic therapy.
Mentions: Patients were divided into three groups based on where the antibiotic courses were delivered—those who received IV inpatient antibiotic therapy for the 14 days, those who were allowed ESD, and those who received domiciliary IV antibiotic therapy for the 14 days. There were 80 patients who received inpatient treatment for 14 days, 32 had ESD and 84 received the full 14 days of domiciliary therapy (Figure 1). The total patient number represents the total number of antibiotic courses as one patient may have received more than one course of antibiotic. The median (interquartile range) duration of inpatient treatment in the ESD group was 8 days (7–11). In all, 74.3% needed IV antibiotics because of failure to respond to oral antibiotics, 10.2% had a pathogen requiring IV antibiotic therapy and 15.5% had severe exacerbations necessitating inpatient admission.

Bottom Line: There was significant clinical and quality of life improvement in all groups, with resolution of infection in 76% in the inpatient group, 80% in the ESD group and 80% in the domiciliary group.No mortality was recorded in either group.Total bed days saved was 1443.

View Article: PubMed Central - PubMed

Affiliation: Centre for Inflammation Research, Queen's Medical Research Institute, Edinburgh, UK.

ABSTRACT

Background: We introduced domiciliary intravenous (IV) antibiotic therapy in patients with bronchiectasis to promote patient-centred domiciliary treatment instead of hospital inpatient treatment.

Aim: To assess the efficacy and safety of domiciliary IV antibiotic therapy in patients with non-cystic fibrosis bronchiectasis.

Methods: In this prospective study conducted over 5 years, we assessed patients' eligibility for receiving domiciliary treatment. All patients received 14 days of IV antibiotic therapy and were monitored at baseline/day 7/day 14. We assessed the treatment outcome, morbidity, mortality and 30-day readmission rates.

Results: A total of 116 patients received 196 courses of IV antibiotics. Eighty courses were delivered as inpatient treatment, 32 as early supported discharge (ESD) and 84 as domiciliary therapy. There was significant clinical and quality of life improvement in all groups, with resolution of infection in 76% in the inpatient group, 80% in the ESD group and 80% in the domiciliary group. Morbidity was recorded in 13.8% in the inpatient group, 9.4% in the ESD group and 14.2% in the domiciliary IV group. No mortality was recorded in either group. Thirty-day readmission rates were 13.8% in the inpatient group, 12.5% in the ESD group and 14.2% in the domiciliary group. Total bed days saved was 1443.

Conclusion: Domiciliary IV antibiotic therapy in bronchiectasis is clinically effective and was safe in our cohort of patients.

Show MeSH
Related in: MedlinePlus