Oral antibiotics for bone, joint infections decrease length of hospital stay
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Key takeaways:
- Guidelines were changed to have patients with bone and joint infections treated with oral antibiotics.
- This increased the rate of patients discharged on oral antibiotics and decreased length of hospital stays.
Treating patients with bone and joint infections with oral antibiotics led to more patients being discharged exclusively on oral antibiotics and shorter hospital stays without increasing rates of treatment failure, researchers found in a study.
“This study was long overdue,” Daisuke Furukawa, MD, clinical assistant professor of infectious diseases at Standford University School of Medicine, told Healio. “The Oral Versus Intravenous Antibiotic (OVIVA) trial, which was a landmark trial and showed noninferiority of oral antibiotics to IV antibiotics for bone and joint infections was published in 2019.”
“As with implementing any new change, it took some time for us as an institution to overcome the inertia to change the way we practice medicine,” Furukawa said, adding thatsince the OVIVA trial, other institutions have started treating bone and joint infections with oral antibiotics. “So, it was time for us to also make the change.”
The change — an institutional guideline to treat patients with bone and joint infections with oral antibiotics — was implemented in April 2023.
Furukawa and colleagues compared a post-guideline cohort and a historical pre-guideline cohort — both comprised of patients aged 18 years and older who were admitted for bone and joint infections — through a retrospective chart review. The primary outcome was the proportion of patients discharged exclusively on oral antibiotics, whereas secondary outcomes included 90-day treatment failure, length of stay and adverse effects of the treatment.
A total of 186 patients were included in the study — 53 from before the guidelines were implemented and 133 from after. Overall, patients had similar outcomes after the guideline implementation to patients before the change.
Data showed that patients in the post-guideline group were most likely to be discharged exclusively on oral antibiotics (25% vs. 70%), had a shorter length of stay (8 days vs. 7 days) and had fewer peripherally inserted central catheter-related adverse events (6% vs. 1%). There was also no significant difference in 90-day treatment failure (8% vs. 9%).
Additionally, the researchers reviewed patients who failed on oral antibiotics. They explained that rates of treatment failure were primarily driven by patients with diabetic foot infections and poorly controlled diabetes.
According to the study, all patients with diabetic foot conditions who experienced treatment failure had peripheral vascular disease. The authors wrote that this “may have not only affected drug delivery but also likely predisposed them to wound complications and overall risk of infection relapse.”
Furukawa said that the key takeaway from these data is that “an institutional guideline can be effectively implemented to increase oral antibiotic utilization for treatment of bone and joint infections.”
“Our real-life experience adds to the body of evidence that oral antibiotics can safely and effectively treat bone and joint infections and that other institutions should implement a similar practice change to preferentially treat patients with oral antibiotics over IV,” Furukawa said. “Moving forward, we should stop asking the question whether oral antibiotics are just as good as IV antibiotics. In my opinion this is no longer debatable. Instead, we should be asking which patient population may be poor candidates for oral antibiotics who many benefit from IV treatment.”
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