Implementing Oral Antibiotics for Bone and Joint Infections: Lessons Learned and Opportunities for Improvement

Abstract

Background: Although intravenous antibiotics have historically been the standard of care for bone and joint infections, clinical trial data have highlighted the safety and efficacy of oral antibiotics. Despite this, intravenous antibiotics are still commonly used, and evaluations of institutional guidelines advancing oral antibiotic use are limited.

Methods: In April 2023, we implemented a new institutional guideline to preferentially treat patients with bone and joint infections with oral antibiotics. The postguideline cohort was compared with a historical preguideline cohort via retrospective chart review. The primary outcome was the proportion of patients discharged exclusively on oral antibiotics. Secondary outcomes included 90-day treatment failure, length of stay, and adverse effects.

Results: One hundred eighty-six patients (53 preguideline and 133 postguideline) were included in the analysis. Patients in the postguideline cohort were more likely to be discharged exclusively on oral antibiotics (25% vs 70%; P < .01), with no difference in 90-day treatment failure (8% vs 9%; P = .75). Patients in the postguideline cohort had a shorter length of stay than preguideline (median, 8 vs 7 days; P = .04) and trended toward fewer peripherally inserted central catheter-related adverse events (6% vs 1%; P = .07).

Conclusions: An institutional guideline was effective in increasing the proportion of patients with bone and joint infections discharged on oral antibiotics. We observed similar clinical outcomes after implementing the guidelines while reducing length of hospital stay.

Keywords: bone and joint infections; guideline implementation; oral antibiotics; osteomyelitis; periprosthetic joint infections.