Assessment of risk factors associated with outpatient parenteral antimicrobial therapy (OPAT) complications: A retrospective cohort study

Abstract

Objective: To characterize factors associated with increased risk of outpatient parenteral antimicrobial therapy (OPAT) complication. Design: Retrospective cohort study. Setting: Four hospitals within NYU Langone Health (NYULH). Patients: All patients aged ≥18 years with OPAT episodes who were admitted to an acute-care facility at NYULH between January 1, 2017, and December 31, 2020, who had an infectious diseases consultation during admission. Results: Overall, 8.45% of OPAT patients suffered a vascular complication and 6.04% suffered an antimicrobial complication. Among these patients, 19.95% had a 30-day readmission and 3.35% had OPAT-related readmission. Also, 1.58% of patients developed a catheter-related bloodstream infection (CRBSI). After adjusting for key confounders, we found that patients discharged to a subacute rehabilitation center (SARC) were more likely to develop a CRBSI (odds ratio [OR], 4.75; P = .005) and to be readmitted for OPAT complications (OR, 2.89; P = .002). Loss to follow-up with the infectious diseases service was associated with increased risks of CRBSI (OR, 3.78; P = .007) and 30-day readmission (OR, 2.59; P < .001). Conclusions: Discharge to an SARC is strongly associated with increased risks of readmission for OPAT-related complications and CRBSI. Loss to follow-up with the infectious diseases service is strongly associated with increased risk of readmission and CRBSI. CRBSI prevention during SARC admission is a critically needed public health intervention. Further work must be done for patients undergoing OPAT to improve their follow-up retention with the infectious diseases service.

Predictors of adverse safety events and unscheduled care among an outpatient parenteral antimicrobial therapy (OPAT) patient cohort

“…In a large US cohort of OPAT patients, racial disparities in safety outcomes were measured but not observed. 26 In a separate, smaller cohort of US-based patients receiving treatment for prosthetic joint infection, non-White race was associated with PICC-related ED visits. 27 Prior investigations evaluating care transitions beyond those specific to OPAT have demonstrated racial disparities in scheduled and unscheduled care following discharge from acute care.…”

Using antibiotics wisely

“…Krah et al evaluated the economic burden of OPAT versus oral therapy and showed that the average daily cost for OPAT group was $65 (CI 51 to 78 compared to $7 (CI, 4–9) for the oral therapy group, demonstrating more than 9-fold higher costs with OPAT [26]. This does not include CVL complications such as line dislodgement, leak, bleeding, occlusion, thrombosis, and CVL-related BSI, with rates as high as 8.45% [27 ▪ ]. With the growing body of evidence to suggest noninferiority of oral therapy to IV therapy, early transition to oral antibiotic therapy may be more cost-effective [28 ▪▪ ].…”

Off-site facilities: Friend or foe of outpatient parenteral antimicrobial therapy (OPAT)?

“…Multiple studies have outlined worse outcomes or increased risk of complications or readmission in patients lost to ID follow-up. 1,2 Although these researchers hypothesized that communication challenges and possible staffing issues were contributory to loss to follow-up, external validity of the findings could be improved if further characteristics of the acute rehabilitation center, subacute rehabilitation center, and LTCF were shared and existing methods of communication with these facilities described. Herein, we describe our institutional experience with off-site facilities.…”