554. Complications and Intensity of Care of Community-based Parenteral Anti-infective Therapy for Patients with Cardiac Infections
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Community-based parenteral anti-infective therapy (CoPAT) is a treatment option for selected patients with cardiac (endocarditis and cardiac device) infections. This study examines the intensity of care and associated complications of such therapy.
Methods: At the Cleveland Clinic, all pts requiring CoPAT are evaluated and managed by infectious disease (ID) physicians. Pts with cardiac infections discharged between July 1, 2007 and June 30, 2008 were identified from our CoPAT registry. Complications (vascular access issues and antibiotic adverse effects) and intensity of care (hospital readmissions, emergency department [ED] visits, office visits and telephone encounters) were evaluated for 30 days after completion of IV antibiotics or till readmission.
Results: One hundred and ninety-seven pts received 216 CoPAT courses for cardiac infections (68 native valve endocarditis, 53 prosthetic valve endocarditis, and 95 pacemaker/ICD infections; with 28, 19, and 5, respectively, treated medically). Mean CoPAT duration was 23.3 days. Vancomycin was the most prescribed antibiotic (42%), and Staphylococcus aureus the most treated microorganism (27%). Twenty-six pts developed antibiotic adverse effects and 14 had vascular access problems. Three pts died. Healthcare encounters are outlined below.
Healthcare encounter rates per 100 CoPAT courses associated with CoPAT for cardiac infections
Encounter typeNVE(n=68)PVE(n=53)PPM/ICD infections (n=95)
Telephone encounters6989106
Scheduled office visits859383
Urgent office visits4810
ED visits221310
Readmissions351717
Twenty-nine percent of readmissions were for the infection itself or complications of therapy. The ID department handled 61% and 39% of all the telephone and urgent office encounters, respectively.
Conclusion: CoPAT for cardiac infections is associated with a small burden of treatment complications but with substantial intensity of care.
Mitchell Ballin, MD1, Thomas G. Fraser, MD, FSHEA2, Steven Gordon, MD, FIDSA3, Alice Kim, MD4, Jose Navia, MD4, Gosta Pettersson, MD, PhD5, Susan Rehm, MD4, Nabin Shrestha, MD6, Nicholas Smedira, MD4, Christina Stachur, MPH4 and  M. I. Ballin, None..
N. K. Shrestha, None..
C. Stachur, None..
S. M. Gordon, None..
T. G. Fraser, None..
A. I. Kim, None..
N. G. Smedira, None..
G. B. Pettersson, None..
J. L. Navia, None..
S. J. Rehm, None., (1)Infectious Diseases, Cleveland Clinic, Cleveland, OH, (2)Infectious Disease, Cleveland Clinic Foundation, Cleveland, OH, (3)Infectious Disease, Cleveland Clinic, Cleveland, OH, (4)Cleveland Clinic, Cleveland, OH, (5)Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, (6)Cleveland Clinic Foundation, Cleveland, OH

Disclosures:

M. Ballin, None

T. G. Fraser, None

S. Gordon, None

A. Kim, None

J. Navia, None

G. Pettersson, None

S. Rehm, None

N. Shrestha, None

N. Smedira, None

C. Stachur, None