Monitoring infection during switchover to oral antibiotics
July 17, 2016 2:01 PM   Subscribe

Should the hospital be monitoring CRP and other signs of infection when switching over from IV to oral antibiotics?

Family member had spinal surgery, a surgical site infection, and a subsequent revision surgery taking out some but not all of the instrumentation. He has been on IV antibiotics for 8 weeks and there is no sign of the infection flaring up again. It is about time for him to switch to oral antibiotics. The hospital is eager to kick him out. We are concerned about the infection returning after the switchover to oral antibiotics. Should the hospital keep him long enough to do some tests and be reasonably certain the oral antibiotics are effective? Is it normal to discharge the patient at the same time as switching the treatment for such a serious condition? Any information or anecdotes will be appreciated. The infection appeared to be staph. epidermidis, treated so far with vancomycin and teicoplanin.
posted by molla to Health & Fitness (6 answers total)
Yes, it is normal to discharge a patient just as the switch is made from IV to oral antibiotics. Your relative may get another set of labs the day before discharge just to double check nothing is trending in a troublesome direction. Your relative absolutely will need close follow up with his/her surgeon post discharge.

Think of the course of oral antibiotics as the extra insurance against infection coming back rather than the first offense in fighting it. Hospitals themselves are sources of infection and research evidence supports discharging someone as soon as possible so they can finish recuperating in a less potentially infectious environment (i.e. home).

Source: US-based RN working with patients transitioning home from the hospital, often after surgeries where post op complications occurred.
posted by little mouth at 2:37 PM on July 17, 2016 [6 favorites]

Best answer: Cultures from the bacteria responsible for this infection likely have been tested for sensitivities to antibiotics. This is routinely done to guide directed treatment so that patients aren't blasted with broad spectrum antibiotics for longer than needed. He should have been switched to oral antibiotics that his bacteria are sensitive to.

If you have concerns about this it's ok to ask questions of his physicians. If he is followed by an infectious disease specialist they are the experts on antibiotics and are generally pretty nice to talk to.
posted by bobobox at 2:56 PM on July 17, 2016

Best answer: IANYD but IAAD. This is totally, absolutely normal. I'm sure the bacteria have been cultured and the hospital is using antibiotics (IV or PO) that bacteria are susceptible to. I know it seems like the hospital is eager to "kick out" your loved one, but hospitals are great places to catch serious infections (some resistant to a lot of antibiotics), so the sooner a patient can get out, the better.
posted by namemeansgazelle at 3:53 PM on July 17, 2016 [2 favorites]

Best answer: Totally normal. I went from having IV antibiotics to oral with discharge the same day. My blood work indicated that the broad spectrum antibiotics were doing a good job getting my white count down, so it was time to switch to a more targeted one. Hospitals really want patients to go home; the risk of Staph and MRSA is so much less at home vs. at the hospital. Plus, patients need rest, lots of rest, and that is hard to get in the hospital.
posted by cooker girl at 6:00 PM on July 17, 2016

Response by poster: Thanks for the responses! The doctor said today that they won't do oral antibiotics, because it is resistant to them. That is confusing, because I know from looking at the hospital records just now that it is in fact susceptible to tetracycline and a couple others. Should we interpret the doctor as meaning that the side effect of the available oral antibiotics would outweigh the benefits? (I am not in the room with the patient and doctors, so I can't ask these questions directly).
posted by molla at 6:07 PM on July 17, 2016

Best answer: The antibiotics the bacteria is susceptible to may not penetrate the area of the infection well or there may be some other reason why they're not appropriate for this particular infection. Tetracycline in particular is an old antibiotic that's currently used mostly for acne and for certain non-bacterial infections like Lyme disease. The antibiotic susceptibility panels tend to be standardized, broad, and don't take into account the location of the infection, so it's very common to get susceptibility profiles for antibiotics you'd never consider using for a particular infection. Without knowing the location of the infection or the particular pathogen they're trying to cover it's hard to say much.
posted by The Elusive Architeuthis at 7:30 PM on July 17, 2016

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