Partial Economic Evaluation and Clinical Impact of a Stewardship Quality-Improvement Intervention to Reduce...

Surgical site and community-acquired osteoarticular infections cause prolonged hospitalization, high costs, and health system burden. Although early intravenous-to-oral (IV-to-PO) antibiotic switch is internationally established, adoption remains limited in Brazil.

To evaluate the effectiveness and direct medical costs of a structured IV-to-PO switch protocol targeting ≤5 days of IV therapy for these infections.

Quasi-experimental before-after study in a public tertiary hospital in southern Brazil. Microbiologically confirmed adult patients were included in retrospective control (January-October 2023; n = 60) or prospective intervention cohort (December 2023-May 2024; n = 29) after protocol implementation by infectious disease specialists and clinical pharmacists.

therapeutic success (clinical improvement, declining inflammatory markers, oral tolerance). Antimicrobial costs were estimated from public health system perspective using microcosting (2024 Brazilian reais [BRL]).

Median hospital length of stay decreased from 12 days (IQR 8-17) to 8 days (IQR 6-13; P = .019). IV antibiotic duration was halved-from 10 days (IQR 7-14) to 5 days (IQR 4-8; P < .001), with increased oral use (P = .007). Therapeutic success was numerically higher in the intervention group (88.9% vs 71.7%; P = .140). Median antimicrobial costs declined from BRL 707.32 (IQR 438.25-1141.92) to BRL 351.40 (IQR 193.82-588.34; P < .001). A 4-day stay reduction may yield significant savings because bed-days are the primary cost of complex infections in public health system.

A structured ≤5-day IV-to-PO protocol in a Brazilian public hospital safely reduced stays and costs without compromising outcomes, supporting stewardship in resource-constrained settings. Future studies should include hospital bed-day costs beyond antimicrobial expenses.