464. Safety and Efficacy of Direct Physician-Operated Infusion Center (POIC) Admissions for Antibiotic Treatment of Osteomyelitis (OSTEO) and Complicated Skin and Skin Structure Infections (cSSSI)
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: POICs provide an alternate treatment site for patients with severe infections. Avoiding hospital admission has numerous benefits that include reduction of nosocomial infection risk and adverse events. The study purpose was to evaluate outcomes of POIC-initiated intravenous antibiotics (IVAB) for the treatment of serious infections, including OSTEO and CSSSIs in patients without immediate prior hospitalization.
Methods: We conducted a retrospective database and chart review of all adult pts receiving IVAB in 2008. Patients without immediate prior hospitalization, defined as 72 hours prior and diagnosed with either OSTEO or cSSSI were evaluated. The primary outcome was clinical success rate, defined as cure + improving, with secondary outcome of adverse events (AEs).
Results: Of 248 patients reviewed, 89 (35%) were directly admitted to the POIC for IVAB without prior hospitalization. 24 patients (28%) had OSTEO and 65 (72%) cSSSI. For both diagnoses, the overall success rate (cure + improving) was 96% (79% + 17%). Success rate for OSTEO was 100% and for cSSSI was 94%. Mean age was 52 (range 20-80); mean weight was 99kg, with 48% males. Diabetes was present in 41 patients (46%) and renal disease in 21 (24%). Predominant site of infection was the foot. Methicillin-resistant Staphylococcus aureus (MRSA) was the most commonly reported pathogen (37%) overall. Vancomycin was the most used antibiotic. AEs were reported in 19 patients (21%), 17 (19%) mild and 2 (2%) serious. All resolved or were treated without sequelae. One catheter-related infection was reported in 2146 total IVAB treatment days. POIC therapy resulted in large cost-savings per day compared to hospitalization for the area.
Conclusions: Treatment of patients with IVAB in an Infectious Disease POIC without prior hospitalization appears to be safe and effective for OSTEO and cSSSI. Further prospective studies can confirm these findings.
Richard Prokesch, MD1, Maureen Strong, PharmD2, Lucinda Van Anglen, PharmD2 and  R. C. Prokesch, None..
M. K. Strong, None. 
L. J. Van Anglen,
Cubist Role(s): Investigator, Received: Research Grant., (1)Infectious Disease Associates, Riverdale, GA, (2)Healix Infusion Therapy, Sugar Land, TX