Early discharge of infected patients through appropriate antibiotic use.

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Abstract
THREE COMMON community-acquired infections resulting in hospitalization are community-acquired pneumonia (CAP), urinary tract infection (UTI), and cellulitis. Patients hospitalized with these types of infections usually complete their course of antibiotic treatment as outpatients. Economic considerations have forced clinicians to consider strategies for earlier discharge from the hospital, including outpatient parenteral antibiotic therapy (OPAT) and a more rapid switch from intravenous to oral antibiotics.1-4 However, the decision to discharge a patient with OPAT or with oral antibiotics may be delayed, for example, because of fever, which may continue despite optimal antibiotic therapy for several days in patients with cellulitis, CAP, or pyelonephritis.5 While it has been demonstrated that there is no benefit to watching patients for 24 hours in the hospital following defervescence and switch to oral antibiotic therapy, clinicians may continue to keep patients hospitalized for additional but unnecessary observation.6-9 We, therefore, undertook an observational study comparing patients discharged from the hospital by an infectious diseases (ID) hospitalist (L.J.E.) early in their clinical course before defervescence with those discharged from the hospital more conventionally by internal medicine (IM) hospitalists to determine the effect of early discharge on patient outcomes.