Reise Rachel, Usmani Silken A, Morris Earl, Ndai Asinamai, Dewar Marvin A, Vouri Scott Martin
University of Florida College of Pharmacy, Gainesville, FL, and University of Florida Health Physicians, Gainesville, FL, USA.
University of Florida College of Pharmacy, Gainesville, FL, USA.
Am J Health Syst Pharm. 2025 Jan 4. doi: 10.1093/ajhp/zxae409.
In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
Clostridioides difficile infection (CDI) is a hospital-acquired infection commonly treated with oral vancomycin. An institutional policy aimed at reducing costs by substituting compounded liquid vancomycin for capsules may have the unintended consequence of having the liquid formulation prescribed at discharge, potentially delaying patients' access due to a lack of availability in pharmacies or lack of insurance coverage. This study aimed to evaluate hospital readmission rates of patients prescribed either vancomycin capsules or liquid upon discharge.
This was a retrospective cohort study conducted at an academic hospital using electronic health records data over a 6-year timeframe The primary outcomes were all-cause and CDI-specific readmission rates within 30 days of discharge, and secondary outcomes included readmission rates within 60 and 90 days. Baseline characteristics were compared using chi-square or Mann-Whitney U tests. The hazard ratio (HR) for readmission was calculated using a Cox proportional hazards model, and readmission rates were analyzed using a Poisson regression model. All readmissions were confirmed by chart review.
A total of 440 patients (61.3% female; median age, 58 years) were included; of these, 68% (n = 298) were prescribed vancomycin liquid and 32% (n = 142) a capsule form. Baseline characteristics were similar in the 2 groups, with the exception of the presence of inflammatory bowel disease (19.0% vs 6.4%, P < 0.0001) and median length of stay (6 days vs 8 days, P = 0.010). Patients prescribed vancomycin liquid were not more likely to be readmitted within 30 days relative to those prescribed capsule, with an adjusted HR for all-cause readmission of 1.58 (95% CI, 0.92-2.73) and an adjusted HR for CDI-specific readmission of 2.21 (95% CI, 0.72-6.76). However, patients prescribed liquid were more likely to be readmitted within 60 days, with an adjusted HR for all-cause readmission of 1.87 (95% CI, 1.19-2.94) and an adjusted HR for CDI-specific readmission of 2.84 (95% CI, 1.14-7.06).
A hospital pharmacy practice implemented to reduce medication costs may impact vancomycin prescribing at discharge and, in turn, may negatively impact readmission rates for patients with CDI treated with oral vancomycin.
为加快文章发表速度，《美国卫生系统药剂师杂志》在稿件被接受后会尽快将其在线发布。已接受的稿件已经过同行评审和文字编辑，但在进行技术排版和作者校样之前就已在线发布。这些稿件并非最终记录版本，之后将会被最终文章（按照《美国卫生系统药剂师杂志》的格式排版并经作者校样）取代。
艰难梭菌感染（CDI）是一种常见的医院获得性感染，通常采用口服万古霉素进行治疗。一项旨在通过用复方液体万古霉素替代胶囊来降低成本的机构政策可能会产生意想不到的后果，即出院时开具液体剂型的处方，由于药房缺货或缺乏保险覆盖，可能会延迟患者获取药物。本研究旨在评估出院时开具万古霉素胶囊或液体的患者的医院再入院率。
这是一项在一家学术医院进行的回顾性队列研究，使用了6年时间范围内的电子健康记录数据。主要结局是出院后30天内的全因再入院率和CDI特异性再入院率，次要结局包括60天和90天内的再入院率。使用卡方检验或曼 - 惠特尼U检验比较基线特征。使用Cox比例风险模型计算再入院的风险比（HR），并使用泊松回归模型分析再入院率。所有再入院情况均通过病历审查确认。
共纳入440例患者（61.3%为女性；中位年龄58岁）；其中，68%（n = 298）被开具万古霉素液体剂型，32%（n = 142）被开具胶囊剂型。两组的基线特征相似，但炎症性肠病的存在情况除外（19.0%对6.4%；P < 0.0001）以及中位住院时间（6天对8天；P = 0.010）。与开具胶囊剂型的患者相比，开具万古霉素液体剂型的患者在30天内再次入院的可能性并不更高，全因再入院的调整后HR为1.58（95%CI，0.92 - 2.73），CDI特异性再入院的调整后HR为有2.21（95%CI，0.72 - 6.76）。然而，开具液体剂型的患者在60天内更有可能再次入院，全因再入院的调整后HR为1.87（95%CI，1.19 - 2.94），CDI特异性再入院的调整后HR为2.84（95%CI，1.14 - 7.06）。
为降低药物成本而实施的医院药房实践可能会影响出院时万古霉素的处方开具，进而可能对接受口服万古霉素治疗的CDI患者再次入院率产生负面影响。
