Early antibiotic switch and early discharge protocols have not been widely studied in Latin America. Our objective was to describe real-world treatment patterns, resource use, and estimate opportunities for early switch (ES) from intravenous (IV) to oral antibiotics and early discharge (ED) for patients hospitalized with methicillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft-tissue infections (cSSTIs).
This retrospective medical chart review recruited 72 physicians from Brazil to collect data from patients hospitalized with documented MRSA cSSTI between May 2013 and May 2015, and discharged alive by June 2015. Data collected included clinical characteristics and outcomes, hospital length of stay (LOS), MRSA-targeted IV and oral antibiotic use, and ES and ED eligibility using literature-based and expert-validated criteria.
A total of 199 patient charts were reviewed, of which 196 (98.5%) were prescribed MRSA-active therapy. Only four patients were switched from IV to PO antibiotics while hospitalized. The mean length of MRSA-active treatment was 14.7 (SD 10.1) days, with 14.6 (SD 10.1) total days of IV therapy. The mean length of hospital stay was 22.2 (SD 23.0) days. The most frequent initial MRSA-active therapies were vancomycin IV (58.2%), clindamycin IV (19.9%), and daptomycin IV (6.6%). Thirty-one patients (15.6%) were discharged with MRSA-active antibiotics of which 80.6% received oral antibiotics. Sixty-two patients (31.2%) met ES criteria and potentially could have discontinued IV therapy 6.8 (SD 7.8) days sooner, and 65 patients (32.7%) met ED criteria and potentially could have been discharged 5.3 (SD 7.0) days sooner.
Only 2% of patients were switched from IV to oral antibiotics in our study while almost one-third were ES eligible. Additionally, one-third of hospitalized patients with MRSA cSSTI were ED eligible indicating opportunity for reducing IV therapy and days of hospital stay. These results provide insight into possible benefits of implementation of ES/ED protocols in Brazil.