701. Successful, Cost-Saving OPAT Therapy Initiated in a Physician Office Infusion Center (POIC) for Treatment of Osteomyelitis and Complicated Skin and Skin Structure Infections, a 3-Year Analysis
Session: Poster Abstract Session: Skin, Soft Tissue and Joint Infections
Friday, October 21, 2011
Room: Poster Hall B1
  • IDSA 2011 #701_Prokesch_Osteo Skin 3-Yr.pdf (961.3 kB)
  • Background:  OPAT therapy is well-described as safe and effective for patients (pts) requiring continuation of intravenous antibiotics (IVAB) upon discharge.  Many of the >500,000 hospital stays for cellulitis or osteomyelitis (OSTEO) could be avoided, with significant direct and indirect cost savings.  We report a 3-yr analysis of pts treated for complicated skin and skin structure infections (cSSSI) and OSTEO with IVAB in an Infectious Disease POIC.

    Methods:  A retrospective review was conducted of all pts receiving IVAB from 2008-2010.  This was further refined to those treated for cSSSI or OSTEO who received their entire treatment in the POIC without prior hospitalization.  Data included demographics, co-morbidities, infecting organism, drug therapy, adverse events (AEs) and outcomes.  Primary outcome was percentage of clinical success, defined as cured + improving.  Recurrences within 90 days were assessed as failed.  Cost benefit was measured by comparing the POIC costs to the mean hospital stay and associated costs avoided. Inpatient stay and costs were obtained from a public database.  Data was analyzed by Chi Square or Fisher's test.  Regression analysis with a 95% confidence interval was used to assess trends over the 3-yr period.

    Results: From 2008-2010, 820 pts received OPAT through the POIC, with 579 (70%) treated for OSTEO or cSSSI.  Of these, 219 (38%) (79 OSTEO, 140 cSSSI) met criteria, a statistically consistent trend over 3 yrs. Mean age was 53, 51% were male and diabetes was the predominant comorbidity (44%). MRSA was consistently the predominant pathogen in both diagnoses.  Clinical success was consistently (p = 1.0) 90% for both diagnoses over 3 yrs.  AEs were also statistically consistent (p=1.0) at 22%.  Regression analysis demonstrated homogeneity over 3 yrs for diagnoses, treatment success, adverse events, and incidence of MRSA (F < 0.8).  Catheter infection rate was 0.34 days/1000 catheter days.  Estimated 3-yr cost savings were $1.8 million. 

    Conclusion:  Trended data indicates that management and treatment of OSTEO and cSSSI is consistently safe and effective when provided in the community setting through a POIC.  Cost savings are significant compared to inpatient costs for the mean treatment days.



    Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

    Richard C. Prokesch, MD1, Lucinda J. Van Anglen, PharmD2 and Thuy N. Sixt, PharmD2, (1)Infectious Diseases Associates, Riverdale, GA, (2)Healix Infusion Therapy, Inc., Sugar Land, TX


    R. C. Prokesch, Healix: ,

    L. J. Van Anglen, Astellas: Scientific Advisor, Consulting fee

    T. N. Sixt, Healix: Employee, Salary

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.