Antibiotic Fills Linked to Lower Readmission After Patient-Directed Discharge for Endocarditis

A national Medicaid observational study included 19,808 adults with drug use-associated infective endocarditis. Antibiotic fills within three days were less common after patient-directed discharge and were associated with lower odds of 30-day readmission, particularly in that group.

Patient-directed discharge occurred in 27.9% of the cohort.
Three-day antibiotic fills were substantially less common after patient-directed discharge.
Antibiotic fills were associated with lower 30-day readmission odds.
Observational findings do not establish treatment effects.

Researchers used national Medicaid data from 2016–2022 to examine outpatient antibiotic fills and 30-day readmission among adults aged 18–64 with new drug use-associated infective endocarditis. The observational analysis measured fills after discharge to non-facility settings and used a landmark design requiring readmission-free survival for three days after discharge. Among 19,808 patients, 5,519 (27.9%) had a patient-directed discharge.

Antibiotic fills within three days occurred in 17.1% of patients with patient-directed discharge versus 44.2% of other patients (adjusted odds ratio [aOR] 0.25; 95% CI 0.20–0.33). Patient-directed discharge was associated with higher odds of readmission (aOR 1.91; 95% CI 1.65–2.21), whereas an antibiotic fill was associated with lower odds (aOR 0.45; 95% CI 0.40–0.50). The association between filling antibiotics and lower readmission odds was stronger after patient-directed discharge (aOR 0.27; 95% CI 0.21–0.34) than after other discharges (aOR 0.50; 95% CI 0.46–0.55; interaction P<0.001).

The findings identify a treatment-continuity gap. The authors propose planning for possible patient-directed discharge, bedside medication delivery, and expanded oral and long-acting intravenous antibiotic use. However, these strategies were not tested. Observational associations do not establish causality, fills do not confirm adherence, and the landmark design excludes early readmissions. Only the abstract was available for review.

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Source

Clinical Infectious Diseases: Outpatient Antibiotic Fills and 30-Day Readmission Following Patient-Directed Discharge in Drug Use-Associated Infective Endocarditis in a National Medicaid Cohort ↗

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