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Frequency of intravenous-to-oral antibiotic switch in VA hospitalized patients with community-acquired pneumonia
Journal article   Open access   Peer reviewed

Frequency of intravenous-to-oral antibiotic switch in VA hospitalized patients with community-acquired pneumonia

Logan Daniels, Brett Heintz, Brian Lund, Bruce Alexander and Daniel Livorsi
Infection control and hospital epidemiology, 8804099
02/02/2026
DOI: 10.1017/ice.2025.10389
PMID: 41623152
url
https://doi.org/10.1017/ice.2025.10389View
Published (Version of record) Open Access

Abstract

Objective: Professional guidelines recommend an early switch from intravenous (IV)-to-oral antibiotics for community-acquired pneumonia (CAP) to facilitate early discharge and prevent hospital-related complications. However, it is unknown how often these IV-to-oral switches occur in clinical practice.Design: We performed a retrospective cohort study across 124 acute-care Veterans Administration hospitals to measure the frequency of early switches.Patients: Patient-admissions during 2018-2023 who had CAP and were started on IV antibiotics upon admission.Methods: We measured the percentage of hospitalized patients with CAP who had an early switch from IV-to-oral antibiotics, i.e., within 72 hours of admission. In addition, we calculated an observed-to-expected ratio for early switches at each hospital and compared a composite outcome (mortality and/or hospital readmission within 30 days of discharge) at hospitals with switch rates that were higher and lower than expected.Results: Of 31,183 patient-admissions for CAP, 17,282 (55.4%) were switched to oral antibiotics by day three of therapy. Overall, 5,629 (18.1%) died and/or were re-admitted within 30 days. The O:E ratio for early antibiotic switches ranged from 0.78 among hospitals in the lowest quartile to 1.23 in the highest quartile. There was no difference in the composite outcome across quartiles.Conclusion: Early switches from IV-to-oral antibiotics for CAP occurred in half of eligible cases. The frequency of these switches varied widely across facilities. Outcomes among patients at hospitals with high switch rates were comparable to outcomes at hospitals with low rates, thereby supporting the safety of early switches. More concerted efforts to promote these switches are needed.
 Infectious Diseases Life Sciences & Biomedicine Public, Environmental & Occupational Health Science & Technology

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