Switch to Oral Antibiotics effective and Reduces Hospital Stays for Bone and Joint Infections, Study Finds

The management of bone and joint infections has long relied on intravenous (IV) antibiotics. Still, emerging evidence suggests that oral antibiotics could be just as effective for certain patients, offering opportunities for earlier discharge and reduced hospital stays. A recent study evaluating institutional guidelines for switching from IV to oral antibiotics has provided valuable insights into how these guidelines can improve patient care while streamlining hospital operations.

Although intravenous antibiotics have traditionally been the preferred treatment for bone and joint infections, clinical trial evidence has demonstrated the safety and effectiveness of oral antibiotics. Despite this, intravenous therapy remains common, and research evaluating the impact of institutional guidelines promoting oral antibiotics is still limited. To fill this knowledge gap, Marten R Hawkins, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, and colleagues evaluated institutional guidelines for switching from IV to oral antibiotics. They provided valuable insights into how these guidelines can improve patient care while streamlining hospital operations.

For this purpose, the researchers implemented a new institutional guideline in April 2023 to prioritize oral antibiotics for treating bone and joint infections. Using a retrospective chart review, they compared a cohort of patients treated under the new guideline with a historical cohort.

The primary outcome was the proportion of patients discharged on oral antibiotics alone, while secondary outcomes included 90-day treatment failure rates, length of hospital stay, and adverse effects. This approach assessed the effectiveness and safety of transitioning from intravenous to oral antibiotics in managing bone and joint infections.

The following were the key findings of the study:

• 186 patients were included in the analysis, with 53 in the pre-guideline cohort and 133 in the post-guideline cohort.
• The post-guideline cohort was more likely to be discharged exclusively on oral antibiotics (70% versus 25%).
• There was no significant difference in 90-day treatment failure between the two cohorts (8% in the pre-guideline group versus 9% in the post-guideline group).
• Patients in the post-guideline cohort had a shorter length of stay (median: 7 days versus 8 days).
• The post-guideline cohort showed a trend toward fewer PICC-related adverse events (1% versus 6%).​

“The findings showed that implementing an institutional guideline improved the proportion of patients with bone and joint infections discharged on oral antibiotics. The study showed that, after the guideline was introduced, clinical outcomes remained similar to those observed with intravenous antibiotics, leading to reduced hospital stays​,” the researchers concluded.

Reference:

Hawkins, M. R., Thottacherry, E., Juthani, P., Aronson, J., Chang, A., Amanatullah, D. F., Markovits, J., Shen, S., Holubar, M., Andrews, J. R., Parsonnet, J., & Furukawa, D. Implementing oral antibiotics for bone and joint infections: Lessons learned and opportunities for improvement. Open Forum Infectious Diseases. https://doi.org/10.1093/ofid/ofae683