In-hospital observation after antibiotic switch in pneumonia: A national evaluation

PURPOSE: To evaluate the clinical benefit of in-hospital observation after the switch from intravenous (IV) to oral antibiotics in a large Medicare population. Retrospective studies of relatively small size indicate that the practice of in-hospital observation after the switch from IV to oral antibiotics for patients hospitalized with community-acquired pneumonia (CAP) is unnecessary. METHODS: We performed a retrospective examination of the US Medicare National Pneumonia Project database. Eligible patients were discharged with an ICD-9-CM diagnosis consistent with community-acquired pneumonia and divided into 2 groups: 1) a not observed cohort, in which patients were discharged on the same day as the switch from IV to oral antibiotics and 2) an observed for 1 day cohort, in which patients remained hospitalized for 1 day after the switch from IV to oral antibiotics. We compared clinical outcomes between these 2 cohorts. RESULTS: A total of 39,242 cases were sampled, representing 4341 hospitals in all 50 states and the District of Columbia. There were 5248 elderly patients who fulfilled eligibility criteria involving a length of stay of no more than 7 hospital days (2536 not observed and 2712 observed for 1 day patients). Mean length of stay was 3.8 days for the not observed cohort and 4.5 days for the observed for 1 day cohort (P <.0001). There was no significant difference in 14-day hospital readmission rate (7.8% in the not observed cohort vs 7.2% observed for 1 day cohort, odds ratio 0.91; 95% confidence interval [CI] 0.74-1.12; P =. 367) and 30-day mortality rate (5.1% not observed cohort vs 4.4% in the observed for 1 day cohort, odds ratio 0.86; 95% CI, 0.67-1.11; P =. 258) between the not observed and observed for 1 day cohorts. CONCLUSIONS: Our analysis of the US Medicare Pneumonia Project database provides further evidence that the routine practice of in-hospital observation after the switch from IV to oral antibiotics for patients with CAP may be avoided in patients who are clinically stable although these findings should be verified in a large randomized controlled trial. (c) 2006 Elsevier Inc. All rights reserved.