Background At the Michael E. DeBakey Veterans Affairs Medical Center, an interdisciplinary outpatient parenteral antimicrobial therapy (OPAT) clinic was developed in August 2020 during the COVID-19 pandemic (Figure 1). Standardized weekly safety monitoring and clinical follow-up was implemented via tele-OPAT visits by an infectious diseases (ID) pharmacist or ID PA with ID physician oversight. This study aimed to describe the practices implemented through initiation of our OPAT clinic, and its impact on clinical outcomes. Figure 1:Description of intervention and clinic model Methods This retrospective cohort study compared clinical outcomes of veterans receiving home OPAT one year pre- and post-implementation of a dedicated OPAT clinic. OPAT episodes initiated during the intervention period, prescribed for less than 7 days, not completed at time of analysis, administered with hospice services, or at a hemodialysis center, infusion suite, skilled nursing facility or long-term care facility were excluded. The primary endpoint was treatment failure during or within 30 days of OPAT completion defined as requiring repeat OPAT course for the same infection, unplanned admission, unplanned surgical intervention or procedure for additional source control, or death from any cause. Results A total of 191 OPAT episodes were included in the analysis (pre-intervention group, n= 76 vs. post-intervention, n=115). The most common indications for OPAT included bone/joint infections (34%), bacteremia (24%), and endocarditis (13%). Treatment failure was lower in the post-intervention vs. pre-intervention group (29% vs 46%, p = 0.01) with a median time to treatment failure of 24 days. Treatment failures in both groups were primarily driven by unplanned hospital admissions (Table 3). The median time to ID follow-up from OPAT initiation was shorter in the post-intervention vs. pre-intervention arms (6 days vs. 9 days, p< 0.001). The adverse event rate was higher (13% vs. 4%, p= 0.06), and modifications were made more frequently in the post-intervention (49% vs. 29%, p=0.007). Table 1:Demographics and baseline characteristicsTable 2:OPAT indications, antimicrobials, and microbiologyTable 3:OPAT follow-up, complications, and treatment failure Conclusion Implementation of an interdisciplinary OPAT clinic led to shorter time to ID follow-up, more frequent OPAT modifications, and reduced treatment failure. The median time to treatment failure suggests the need for ongoing surveillance beyond the initial 2 weeks of OPAT. Disclosures All Authors: No reported disclosures.
Background A 2016 needs assessment survey of infectious diseases (ID) training program directors revealed gaps in ID fellows’ education including the application of antimicrobial stewardship into clinical practice. Direct involvement of ID trainees in inpatient antimicrobial stewardship (AS) activities has previously been described with favorable outcomes and achievement of program goals. Engagement of ID fellows in outpatient (OP) AS activities including targeted provider feedback has not been well described and may provide opportunity for more hands-on OP AS experience for trainees. Methods Our OP AS program developed a 4-week virtual rotation experience for ID fellows to meet organizational needs for AS education during the COVID-19 pandemic. Acute respiratory tract infection (ARI) was chosen as a disease state priority. The expected progression of the ID fellow was as follows: Week 1: Review Core Elements of outpatient AS, regulatory requirements, and disease state priorities; review available stewardship tracking data sources; Week 2: Review facility-level antibiotic use data for a single outpatient clinic, and identify top 3 antibiotic prescribers in the clinic; Week 3: Deliver a virtual outpatient AS presentation to all providers at a single clinic, and create antibiotic report cards (See Figure 1) for top antibiotic prescribers; Week 4: Conduct 15-min targeted provider feedback sessions using antibiotic report cards for top 3 providers. Example Antibiotic Report Card Results Between September 2021-April 2022, three ID fellows completed the OP AS rotation experience. All fellows completed each week of the rotation successfully. Solicitation of feedback from providers receiving targeted feedback sessions (See Figure 2) is ongoing, and a standardized feedback form will be sent to all ID fellows completing the rotation at the end of the academic year to evaluate the program’s success in meeting pre-specified learning objectives. The rate of antibiotic prescribing for uncomplicated acute respiratory tract infection will be re-evaluated post-intervention for providers receiving targeted education. Targeted Provider Feedback Survey Conclusion Direct involvement of ID fellows in OP AS activities may be mutually beneficial for trainees and OP AS programs. A virtual format for AS education and intervention was practical and feasible. Disclosures All Authors: No reported disclosures.
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