758Treatment Complications During Outpatient Parenteral Antimicrobial Therapy (OPAT) Administered at Home

Shrestha, Nabin K.; Shrestha, Jugnu; Everett, Angela; Carroll, Don; Gordon, Steven M.; Rehm, Susan J.

doi:10.1093/ofid/ofu052.466

Cited by 3 publications

(4 citation statements)

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“…In this study we found that the majority of complications were line related (21/247). This is consistent with that of previous studies [ 11 , 18 ]. Surprisingly, only 16 of the 247 (6%) patients were found to have antibiotic-related ADE documented.…”

Section: Discussionsupporting

confidence: 94%

Risk factors for readmission among patients receiving outpatient parenteral antimicrobial therapy: a retrospective cohort study

et al. 2022

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In the Netherlands, home treatment with intravenous antimicrobial therapy is a relatively new concept. Although several studies have shown that outpatient parenteral antimicrobial therapy (OPAT) can be administered safely, people receiving antimicrobials at home remain at risk for adverse events, including readmission. The aim of our retrospective study was to identify risk factors for readmission in patients discharged with OPAT. Patients who were at least 18 years or older, discharged with OPAT between January 2016–December 2018 were included. Variables that were collected consisted of baseline demographics, complications, readmission within 30 days and treatment failure. Multivariate logistic regression analysis was performed to identify risk factors for readmission. A total of 247 patients were included; the most common reason for OPAT was bone and joint infections (17%). Penicillin (37%), cephalosporin (26%) and vancomycin/aminoglycoside (15%) were the most commonly prescribed antimicrobials. Among patients receiving medication subject to therapeutic drug monitoring (i.e. aminoglycosides or vancomycin), 51% (19/37) received weekly therapeutic drug monitoring. Receiving aminoglycosides or vancomycin (adjusted OR 2.05; 95% CI 1.30–3.25, p < 0.05) and infection of prosthetic material (adjusted OR 2.92, 95% CI 1.11–7.65, p < 0.05) were independent risk factors associated with readmission. Although patients receiving medication subject to therapeutic drug monitoring are at higher risk of readmission, only half of the patients discharged with aminoglycosides or vancomycin were monitored according to IDSA guidelines. A specialized team in charge of monitoring patients with OPAT is more likely to increase the rate of monitoring to prevent readmissions and complications.

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Section: Discussionsupporting

confidence: 94%

Risk factors for readmission among patients receiving outpatient parenteral antimicrobial therapy: a retrospective cohort study

et al. 2022

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“…Additionally, patients could not receive any concomitant antibiotics after the studied antibiotic was initiated. Patients were excluded from evaluation if any of the following applied: a diagnosis of infective endocarditis, either a neutrophil count <500 cells/mm [ 3 ] or a diagnosis of HIV at the time that the blood culture was drawn, another organism in blood culture that was not susceptible to the studied antibiotic, or a culture from another sterile site growing an organism that was not susceptible to the studied antibiotic.…”

Section: Methodsmentioning

confidence: 99%

“…Additionally, long-term intravenous (IV) access is associated with complications. In one study observing patients at the Cleveland Clinic receiving OPAT, 9% (176/1950) of the OPAT courses experienced a vascular access complication; occlusion was the most common event [ 3 ]. In a study conducted in the United Kingdom, line-related complications among patients receiving OPAT were significantly more common than drug-related adverse effects at 5.9% vs 2.4% [ 4 ].…”

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confidence: 99%

Oritavancin vs Standard of Care for Treatment of Nonendovascular Gram-Positive Bloodstream Infections

Moenster,

Wallace-Lacey,

Western

et al. 2023

Open Forum Infectious Diseases

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Background Data is limited comparing oritavancin (ORT) to the standard-of-care (SOC) for the treatment gram-positive blood stream infections (BSI). Methods This was a retrospective study of all patients in the Veteran's Affairs Health Care System treated with at least 1 dose of oritavancin or at least 5 days of vancomycin, daptomycin, ceftaroline, ampicillin, ampicillin-sulbactam, nafcillin, oxacillin, or cefazolin for a documented gram-positive BSI from 1 January 2015 to 30 June 2021. Patients with polymicrobial blood cultures or positive cultures from other sites were included if the organisms were sensitive to the incident antimicrobial; no concomitant antimicrobials could be used once the incident agent was started. Individuals were also excluded if they were diagnosed with endocarditis, had a neutrophil count 96-hours of treatment before the incident antimicrobial was started. The primary composite outcome was clinical failure, defined as all-cause mortality within 30-days from the end of therapy, or blood cultures positive for the incident organisms ≥72 hours after administration of the first dose and ≤30 days after the administration of the final dose of the study antimicrobial, or any drug or line-related readmissions within 30-days of hospital discharge. Results Two hundred-forty patients were identified for screening with 96 meeting criteria (27 in ORT and 69 in SOC groups). Baseline characteristics were generally balanced between groups except more patients in the ORT group received >96-hours of treatment before the incident antimicrobial was started (70.3% (19/27) vs 13.04% 9/69); P < .001). The pathogen most prevalent was methicillin susceptible Staphylococcus aureus (MSSA) (ORT 33.3% (9/27) vs SOC 46.4% (32/69)). Clinical failure occurred in 7.4% (2/27) in the ORT group and 17.4% (12/69) in SOC (P = .34). No components of the primary outcome were significantly different between groups, but AKI did occur more commonly in the SOC group (27.5% (19/69) vs 3.7% (1/27); P = .01). Conclusions ORT appears to be a safe and effective option when directly compared to the SOC for non-endocarditis BSIs.

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“…The most common complication was occlusion (49%), followed by accidental dislodgement (14%). Thrombosis and line infection occurred less frequently at rates of 0.34 and 0.16/1,000 OPAT days, respectively ( 8 ). However, recent studies of this method have not described increases in hospital readmissions nor complications in comparison with administration in the presence of a healthcare worker ( 3 ).…”

Section: Opat Trends and The Concept Of Oscat In Clinical Practicementioning

confidence: 99%

Outpatient Subcutaneous Antimicrobial Therapy (OSCAT) as a Measure to Improve the Quality and Efficiency of Healthcare Delivery for Patients With Serious Bacterial Infections

et al. 2020

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Since the 1970s, outpatient parenteral antimicrobial therapy (OPAT) has been a viable option for patients who require intravenous antibiotics when hospitalization is not warranted. While the benefits of OPAT as a measure to improve the efficiency of healthcare delivery (i.e., reduced hospital days) and patient satisfaction are well-documented, OPAT is associated with a number of challenges, including line complications and reliance on daily healthcare interactions in some cases at home or in a clinic. To minimize the continued need for intensive healthcare services in the outpatient setting, there is trend toward patients self-administering antibiotics at home without the presence of healthcare workers, after adequate training. In most cases, patients administer the antibiotics through an established intravenous catheter. While this OPAT practice is becoming more accepted as a standard of care, the potential for line complications still exists. Outpatient subcutaneous antimicrobial therapy (OSCAT) has become an increasingly accepted alternative route of administration of antibiotics to IV by French infectious diseases physicians and geriatricians; however, currently, no antibiotics are approved to be administered subcutaneously. Antibiotics with longer half-lives that are completely absorbed and have a favorable local tolerability profile are ideal candidates for OSCAT and have the potential to maximize the quality and efficiency of parenteral antibiotic delivery in the outpatient setting. The increasing development of wearable, on-body subcutaneous delivery systems make OSCAT even more viable as they increase patient independence while avoiding line complications and potentially removing the need for direct healthcare professional observation.

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758Treatment Complications During Outpatient Parenteral Antimicrobial Therapy (OPAT) Administered at Home

Cited by 3 publications

References 0 publications

Risk factors for readmission among patients receiving outpatient parenteral antimicrobial therapy: a retrospective cohort study

Risk factors for readmission among patients receiving outpatient parenteral antimicrobial therapy: a retrospective cohort study

Oritavancin vs Standard of Care for Treatment of Nonendovascular Gram-Positive Bloodstream Infections

Outpatient Subcutaneous Antimicrobial Therapy (OSCAT) as a Measure to Improve the Quality and Efficiency of Healthcare Delivery for Patients With Serious Bacterial Infections

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