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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Title Template,First Bullet Example,Second Bullet,Third Bullet,Fourth Bullet,Fifth Bullet,Title Template,First Bullet Example,Second Bullet,Third Bullet,Fourth Bullet,Fifth Bullet,Title Template,First Bullet Example,Second Bullet,Third Bullet,Fourth Bullet,Fifth Bullet,Sentence case point 32 arial,Click to edit master text styles,Second level,Third level,Fourth level,Fifth level,Sentence case point 32 arial,Click to edit master text styles,Second level,Third level,Fourth level,Fifth level,Title in any of these colours,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,IV/Oral Switch andEarly Discharge Strategies,Matthew Dryden MD,Royal Hampshire Hospital,Winchester,UK,Southampton University,matthew.,Disclosures and Acknowledgements,Research and educational grants,honoraria and Advisory board member:Pfizer,Bayer HealthCare,AstraZeneca,Janssen-Cilag and Basilea,I am grateful to colleagues who collaborated with collecting antibiotic management and early discharge data,Name,Location,Phil Howard,Leeds,Rob Townsend,Sheffield,Brian Jones/John Coia,Glasgow,Kathy Bamford/Wendy Lawson,Imperial,London,Rhidian Morgan-Jones,Cardiff,Paul Wade,St Thomas,London,Das Pillay/Peter Hawkey,Birmingham,IV or Oral?,Which of the Following Criteria are Important for an Early Switch From IV to Oral in a Patient With MRSA Infection Able to Take Oral Medication?(choose all that apply),%,Dryden M et al.Clin Microbiol Infect 2010;16(Suppl 1):3-31,Conditions that might require more prolonged IV antibiotics,S.aureus bacteraemia,Necrotising cSSTI,Severe infections in chemotherapy and neutropenia,Infected implants/prostheses,Meningitis/encephalitis,Intracranial abscesses,Mediastinitis,Empyema,Endocarditis,Exacerbation of CF/bronchiectasis,Inadequately drained abscess,Liver abscess,Cavitating pneumonia,Osteomyelitis,Septic arthritis,UK NHS(England)Health statistics,14 million people are admitted to hospital each year and the,NHS treats a million people every 36 hours.,In 2009-10,total of 1,899 MRSA bacteraemias,25,605,C.difficile,infections.,Average Length of Stay in Hospital for All Causes,Europe 2000 and 2008,Source:OECD Health Data 2010;Eurostat Statistics Database.,EU,8.3 days,2000,7.2 days,2008,Florence Nightingale,Scutari,1850,Mens emergency ward.East London 1860s,Perhaps care at home would be an improvement,Hospital or Home Care,Hospital,Expertise,Close observation,Monitoring,Expensive,HC complications,Home,Patient preference,More comfortable,Improved recovery,Less monitoring or observation,IV OPAT,Home environment,Continued attendance at work/school,Reduced risk of HCAI,Better use of hospital beds,Patient empowerment,Reduced HC costs,Disruption to home life,Stressful for family,Compliance,Misuse of IV access,Decreased supervision,Access to emergency care,Non-adherence to medical advice,Advantages,Disadvantages,Nathwani D et al,JAC.2009;64(3):447-53.,Outpatient Antibiotic Use in DDD in 20 European Countries,Coenen et al JAC(2009)64,200205.,Parenteral antibiotic use as a proportion of total outpatient antibiotic use,Coenen et al JAC(2009)64,200205.,Length of Stay,The mean length of hospital stay at EOS was significantly shorter in the linezolid group than in the vancomycin group,1,P=0.022,P=0.016,1 Itani K,et al.Am J Surgery,2010;,199(6):804-16.,Mean length of stay,days,*Vancomycin dose adjusted for creatinine clearance and trough levels,GOing Home Study,Hammersmith and,Charing Cross,Hospitals,London,Wendy Lawson,Lead Pharmacist,Infectious Diseases,Hammersmith Hospital,G,lycopeptides to,O,ral treatment at,HOME,study,Results,Bamford K et al.Clin Microbiol Infect 2008;14:Suppl 7:S362.,52%patients,had intervention made,Post Discharge Follow Up,Patients GP informed about study recruitment,All patients reviewed by telephone by SP at end of antibiotic treatment,Patients switched to linezolid monitored weekly at clinic appointment,Routine follow up by teams,Only 1 patient readmitted within 28 days for unrelated reason,Bamford K et al.Clin Microbiol Infect 2008;14:Suppl 7:S362.,Antibiotic Early Discharge Service Evaluation,Antibiotic Management and Early Discharge,Patient+Antibiotic,Continue?Stop?,Need for IV route?Discharge?,Switch IV to Oral?,Does the patient need to be in hospital?,Reasons preventing Discharge?,Suitable for OPAT(IV or oral)?,Compare potential Discharge Date with Actual Discharge Date -bed days saved,Collect Data,multiple sites across UK,-Clinical and health economic outcomes,Develop Standards of Care for early discharge in infection and care in the community,Results,1356 patients reviewed in acute medical and surgical wards in 6 Hospitals;,429(32%)were on antibiotics,165/429(38%)on IV;264/429(62%)on oral,Stop,99(23%)could stop antibiotic immediately,26 pat
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