• P P Velu, P Bedi, K Turnbull, and A T Hill.
• From the Department of Respiratory Medicine, Royal Infirmary of Edinburgh, 51 Little Frances Crescent, Edinburgh EH16 4SA, UK prasad.velu@nhslothian.scot.nhs.uk.
• QJM. 2016 Nov 1; 109 (11): 723-729.

BackgroundThe safety and efficacy of domiciliary intravenous (IV) antibiotic therapy compared to inpatient hospital treatment for exacerbations of bronchiectasis has been established. Factors that determine the setting for IV antibiotic therapy need to be characterized further.AimWe aimed to identify factors at presentation that were associated with the requirement for IV antibiotic therapy delivered in hospital and 30-day readmission.DesignRetrospective cohort study of all IV antibiotic courses administered to patients with bronchiectasis by a specialist respiratory unit over a 2-year period.MethodsWe assessed demographic data, treatment outcomes, morbidity, mortality, and 30-day readmission rates. Multiple linear regression analysis was performed to identify factors associated with inpatient IV antibiotics and 30-day readmission.ResultsOne hundred six patients received 243 courses of IV antibiotic therapy in 2 years. Sixty-six cases (27.2%) were managed in hospital, 28 cases (11.5%) required initial admission prior to early supported discharge to complete IV antibiotics at home and 149 cases (61.3%) received domiciliary IV antibiotics. Bronchiectasis Severity Index (P < 0.0001) and emergency presentation with an exacerbation (P < 0.0001) were independent factors associated with the requirement for inpatient IV antibiotic therapy. There were no differences between mortality (P = 0.06) and morbidity (P = 0.1) between groups. Thirty-day readmission following early supported discharge was higher compared to inpatient or domiciliary therapy (P=0.0004).ConclusionA higher Bronchiectasis Severity Index and emergency presentation with an exacerbation are independently associated with the need for IV antibiotics delivered in hospital. We could not identify any factors that predicted 30-day readmission in a multi-variable model.© The Author 2016. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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