A step further: Antibiotic stewardship programme in home hospital.

Abstract

Objective: To evaluate the adequacy of empirical antibiotic prescription and the duration of antibiotic therapy for infected patients admitted for conventional hospitalization (CH) and Hospitalization at Home (HaH) after implementation of an antibiotic stewardship programs (ASP) in HaH.

Design: Retrospective cohort study.

Patients: Patients admitted for infection to Emergency Department between October and December 2023. "CH-ASP cohort" was admitted to CH with ASP intervention, "CH cohort" was admitted to CH without ASP intervention, "HaH cohort" was admitted to HaH (integrated daily ASP intervention).

Results: Ninety-one patients were analyzed in CH-ASP, 60 in CH, and 101 in HaH. The ASP made recommendations on empirical antibiotic therapy for 175 patients (92 %) with a 98 % acceptance rate. For 111 patients (44 %) the ASP made recommendations on antibiotic duration (24 % CH-ASP vs 89 % HaH, p < 0.001), with a 73 % acceptance rate (41 % CH-ASP vs 81 % HaH, p < 0.001). Empirical antibiotic adequacy was 94 % (93 % CH-ASP vs 87 % CH vs 100 % HaH, p = 0.006). Median duration of antibiotic therapy was nine days in CH-ASP and CH vs seven in HaH (p < 0.001). There were no differences in mortality and readmissions. In the multivariate analysis, patients in CH-ASP and CH had total duration of antibiotic therapy of 2.2 (95 % CI: 0.2-4.2) and 3 days more (95 % CI: 0.8-5.3) respectively as compared to HaH.

Conclusions: ASP improves empirical antibiotic adequacy in patients admitted for infection. ASP in HaH, because of high acceptance of intervention regarding antibiotic duration, achieves shorter treatment durations without increased mortality or readmission.