Introduction Recurrent exacerbations requiring IV antibiotic therapy are a feature of advanced bronchiectasis. Our group has previously established the safety and efficacy of domiciliary antibiotic therapy compared to inpatient hospital treatment for exacerbations of bronchiectasis. In this study we aimed to identify factors at presentation that could predict the requirement for inpatient antibiotic therapy compared to domiciliary antibiotic therapy.
Methods We assessed the management of bronchiectasis exacerbations referred to a specialist respiratory unit over a 1-year period (April 2013 to 2014). All patients received 10 to 14 days of IV antibiotic therapy and were assessed at the beginning and end of their treatment course. We assessed demographic data, treatment outcomes, morbidity, mortality and 30-day readmission rates. Logistic regression analysis was performed to identify factors predictive of the treatment modality used.
Results A total of 72 patients were treated with 131 courses of IV antibiotic therapy. Thirty-six cases (27.5%) were managed as inpatients, 20 cases (15.2%) required initial admission and subsequently received early supported discharges (ESD) to complete IV antibiotic therapy at home and 75 cases (57.2%) received domiciliary IV antibiotics.
Logistic regression showed that Charlson Co-morbidity Index was independently predictive of the requirement for inpatient antibiotic therapy (p = 0.03). White Cell Count at presentation was also positively associated with the requirement for inpatient antibiotic therapy approaching statistical significance (p = 0.05).
There were no mortalities in the ESD or domiciliary antibiotic groups but 2 mortalities (5.6%) were noted in the inpatient group (Table 1). Morbidity in the inpatient, ESD and domiciliary antibiotic groups were 8.3%, 5.0% and 2.9% respectively (p = 0.40). The median length of stay before early supported discharge was 7 (interquartile range 7 – 9) days. Thirty-day readmission rates were 11.1%, 25.0% and 2.7% respectively (2 × 3 Chi-square; p < 0.05). Total bed days saved from ESD and domiciliary antibiotic therapy was 1153 days (interquartile range 9–14).
Conclusions Our study has demonstrated that the Charlson Co-morbidity Index is the independent risk factor that predicts the need for inpatient intravenous antibiotic therapy in exacerbations of bronchiectasis. Those patients that received domociliary treatment received it safely.