Cost implications of home care on serious infections.

More than 250,000 Americans will receive home IV drug therapy this year. Antibiotics will account for two-thirds of this care. Over 60% of infections treated at home are caused by gram-positive cocci, with staphylococci accounting for approximately 24% of the pathogens. Bone and joint infections represent the most common diagnoses among patients receiving parenteral antibiotics at home, and many of the infections treated at home were initially acquired in the hospital. The most common serious complications of coronary bypass surgery, the most frequently performed operation in many hospitals, are sternal wound infections are methicillin-resistant The major pathogenic causes of these infections are methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis. These complications are usually treated with prolonged inpatient IV therapy and surgery. In a study in which patients with sternal wound infections or mediastinitis secondary to coronary bypass surgery were treated with teicoplanin, preliminary results showed that the mean postoperative hospital stay was decreased by more than 7 days compared with patients receiving other types of antibiotic therapy. This was accomplished by changing from intravenous to intramuscular therapy as soon as the patient became stabilized and then discharging the patient after an additional 2 days to complete intramuscular therapy at home. In addition to enhancing the quality of life for the patient by allowing early hospital discharge and early ambulation, home therapy offers the additional benefits of decreasing the risk of cross infection to other patients, as well as to the already infected patient.