PSHP 2026 Residency Conference

Purpose:
To evaluate early transition (at day 3 or less) compared to late transition (after day 3) of intravenous (IV) to oral (PO) antibiotics on clinical outcomes. 


Methods:
This study utilized retrospective chart review of patients treated for CAP within Lankenau Medical Center (LMC). Adult patients were included if they met CAP criteria published in the IDSA guidelines and received at least 3 days of antibiotic therapy. Patients were excluded if they did not meet criteria for transition to oral therapy in IDSA CAP guidelines, transferred from another inpatient facility, had concomitant infection treatment, or admitted to an intensive care unit on the day of antibiotic initiation. The primary outcome compared 30-day readmission rates between patients transitioned to PO before and after day 3 of antibiotics. Key secondary outcomes were compared between these groups and included 90-day all-cause mortality, hospital length of stay, total antibiotic days of treatment, and Clostridium difficile infection at day 90. 


Results:
676 patients were screened for meeting criteria, of which 50 met inclusion criteria. Six of these patients met early transition criterion, with 44 qualifying for late transition. Baseline characteristics across the two treatment groups were similar in Charlston Comorbidity Index and Pneumonia Severity Index scores. Thirty-day readmission occurred in 8 (18.2%) of the late transition group, with no readmissions in the early transition group. One patient within the late transition group did have mortality at 90 days, while no patients within the early transition group met this criterion. Both treatment groups had a median length of hospital stay of 5 days. 


Conclusion:
For patients meeting IDSA criteria, early transition to oral antibiotics in CAP patients was associated with decreased 30-day readmission rates as compared to late PO transition.