Background Although widely accepted for adults, the safety of outpatient parenteral antimicrobial therapy (OPAT) in very old patients has not been examined. Methods Nonagenarians (age ≥90 years) discharged from the hospital on OPAT over a 5-year period were identified from the Cleveland Clinic OPAT Registry. Three matched controls (<90 years) were selected for each nonagenarian. Times to OPAT-related emergency department (ED) visit and OPAT-related readmission were compared across the 2 groups in multivariable subdistribution proportional hazards competing risks regression models. Incidence of adverse drug events and vascular access complications were compared using negative binomial regression. Results Of 126 nonagenarians and 378 controls, 7 were excluded for various reasons. Among the remaining 497 subjects, 306 (62%) were male, 311 (63%) were treated for cardiovascular or osteoarticular infections, and 363 (73%) were discharged to a residential health care facility. The mean (SD) ages of nonagenarians and controls were 92 (2) and 62 (16) years, respectively. Compared with matched controls, being a nonagenarian was not associated with increased risk of OPAT-related ED visit (hazard ratio [HR], 0.77; 95% CI, 0.33–1.80; P = .55), OPAT-related readmission (HR, 0.78; 95% CI, 0.28–2.16; P = .63), adverse drug event from OPAT medications (incidence rate ratio [IRR], 1.00; 95% CI, 0.43–2.17; P = .99), or vascular access complications (IRR, 0.66; 95% CI, 0.27–1.51; P = .32). Nonagenarians had a higher risk of death overall (HR, 2.64; 95% CI, 1.52–4.58; P < .001), but deaths were not from OPAT complications. Conclusions Compared with younger patients, OPAT in nonagenarians is not associated with higher risk of OPAT-related complications. OPAT can be provided as safely to nonagenarians as to younger patients.
BackgroundAlthough OPAT is widely accepted practice for adults in the USA, the safety of OPAT in very old patients has not been examined before.MethodsThe Cleveland Clinic OPAT Registry was screened to identify patients aged 90 and above discharged from hospital on OPAT. Control subjects (those aged 89 years and younger) were selected from the OPAT registry, matched to study subjects on sex, year of admission, OPAT site, vascular access, infection category, and antibiotic group. ED visits, readmissions, and deaths, for nonagenarians and controls, were described as competing outcomes. Patients were only included once. Events up to 90 days following initiation of OPAT were considered. OPAT-related ED visits, and separately OPAT-related readmissions, were compared across the two groups in subdistribution proportional hazards competing risks regression models. Adverse drug events were compared using logistic regression.ResultsThirty nonagenarians and 87 control subjects were identified for patients discharged on OPAT between January 1, 2013 and May 21, 2014. Mean (SD) of age for nonagenarians and controls were 92 (3) and 61 (16), respectively, and 67 (57%) were males. Cardiovascular and osteoarticular infections accounted for more than 50% of infections treated in each group, and the majority of patients received their OPAT in skilled nursing facilities. The cumulative incidences of OPAT-related ED visits and readmissions for nonagenarians and control patients, with death and non-OPAT-related readmissions accounted for as competing events, are shown in the figure. Compared with matched patients below 90 years of age, nonagenarians were not at increased risk of OPAT-related ED visits (HR 1.32, 95% CI 0.55–3.18, P = 0.54), OPAT-related readmissions (HR 1.2, 95% CI 0.23–6.19, P = 0.83), or adverse drug events from OPAT medications (OR 1.22, 95% CI 0.28–8.55, P = 0.81).ConclusionOPAT can be accomplished in nonagenarians as safely as in younger patients. Disclosures All authors: No reported disclosures.
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