Ambulatory Intravenous Antibiotic Therapy in Quebec: The Hôpital Charles LeMoyne Experience in 1996

From January 1, 1996 to December 31, 1996, 343 patients received outpatient intravenous antibiotic therapy at CharlesLeMoyne Hospital, a 436-bed, acute care hospital in Greenfield Park, south of Montréal, Québec. The infectious diseasesdepartment saved 2660 bed-days using outpatient therapy. The mean duration of outpatient therapy was 7.76 days;81.6% of patients were admitted to the program directly from the emergency room, or outpatient hospital clinics or privateoffices in the community. Hospitalized patients constituted only 18.4% of admissions to the outpatient intravenousantibiotic therapy program. Forty per cent of the surgical/medical staff participated in the program and they were able togenerate a significant impact by diverting patients to outpatient therapy. Two types of patients can benefit from an outpatientintravenous antibiotic therapy program. One group of patients needs empirical short term therapy and can beswitched to oral sequential therapy after two to five days of outpatient intravenous antibiotic therapy. A second group ofpatients needs specific long term therapy for the full duration of the antibiotic therapy. Empirical short term therapy canbe managed by emergency department or hospital-based primary physicians, or medical/surgical specialists. Specificlong term therapy can be managed by microbiology/infectious disease specialists or medical/surgical specialists. Hospitalsthat want to relieve pressure on emergency rooms and hospital bed demands should create facilities for both types ofpatients. Cefazolin and gentamicine/tobramycine were the most commonly used antibiotics in empirical short term therapyand in terms of number of patients treated. Ceftriaxone and vancomycin were most commonly used for long termtherapy. The Drug acquisition antibiotic cost was $73,117 but constituted only 20% of the total outpatient intravenousantibiotic therapy cost. The per diem ambulatory cost was $140/patient/day