IDENTIFICATION OF LOW-RISK HOSPITALIZED-PATIENTS WITH PNEUMONIA - IMPLICATIONS FOR EARLY CONVERSION TO ORAL ANTIMICROBIAL THERAPY

Purpose: Few available data exist to define either the medically neces sary duration of parenteral antimicrobial therapy or length of stay fo r hospitalized patients with pneumonia. Therefore, we investigated the potential safety and effectiveness of a practice guideline recommendi ng early conversion of low-risk patients with pneumonia from parentera l to oral antimicrobial therapy and early hospital discharge. Patients and methods: The practice guideline was studied retrospectively in 50 3 hospitalized patients with pneumonia at a teaching community hospita l. Results: Thirty-three percent of patients with pneumonia were class ified as at low risk for complications and potentially suitable for ea rly conversion to oral antimicrobial therapy according to the guidelin e. Were the guideline to have been used to guide patient discharge dec isions, 619 additional bed-days would have been made available to acco mmodate incoming patients. A consensus among physician reviewers led t o the judgment that quality of care would not have worsened for 98.2 p ercent of low-risk patients had they been switched to oral antimicrobi al therapy on the third hospital day, nor would quality of care have b een worsened for 93.4 percent of low-risk patients had they been disch arged on the fourth hospital day. Conclusion: The practice guideline t hat we studied has the potential to safely reduce the duration of pare nteral antimicrobial therapy and length of hospital stay for selected low-risk patients with pneumonia. The guideline should be studied in a prospective clinical trial.