189. Outcomes and Readmissions of Bacteremia, Endocarditis and Osteomyelitis among Patients Treated with Outpatient Parenteral Antimicrobial Therapy (OPAT) in Infectious Disease Physician Office Infusion Centers (POIC)
Session: Poster Abstract Session: Antibiotic Stewardship
Friday, October 21, 2011
Room: Poster Hall B1
Posters
  • IDSA 2011 Poster 189 Dailey Readmission.pdf.pdf (673.6 kB)
  • Background:  OPAT is well documented to be safe and effective.  However, infections requiring long term therapy are frequently accompanied by high rates of readmissions, recurrences, and complications.   An ID POIC offers a controlled setting for management of OPAT for serious infections, including bacteremia (BAC), endocarditis (IE) and osteomyelitis (OM).  We evaluated outcomes and readmissions for patients (pts) receiving OPAT from this unique setting.

    Methods:  A retrospective, multicenter, observational review was completed in 7 POICs of pts ≥ 16 yrs receiving IVAB for BAC, IE or OM from January 1, 2010 to June 30, 2010.  Data collected from the medical records included demographics, microorganisms, drug therapy characteristics and outcomes, including drug adverse events (AEs) and catheter-related events.  Clinical success was defined as cured or improved.  Hospital readmissions during therapy and 6-month recurrence rates were identified for all patients.   Comparisons were assessed using Fisher's exact test (p = 0.05 significant).

    Results:  Enrollment was 203 pts from all sites. Mean age was 59 yrs. Mean duration of therapy in the POIC was 31 days (BAC 20, IE 31, OM 37), with 32% of pts receiving all therapy in the POIC without hospitalization.  Diabetes was the most prevalent co-morbidity (75, 37%).  Additional results are as follows:

    Readmissions were due to drug-related AEs (4), device failure (4), disease exacerbation (3) and other medical complications (8).  No statistical differences were seen with readmissions or recurrences between diagnoses.   26% of pts reported AEs related to IVAB.  7 pts (3.4%) had serious AEs requiring hospitalization or intervention.  3 pts (1.5%) had catheter device failures.  The catheter infection rate was 0.57 per 1000 catheter days. 

    Conclusion:  Treatment of BAC, IE and OM with OPAT is safe and effective in an ID POIC.  Recurrence rates and unanticipated readmissions appear to be low, particularly for OM and more favorable than previously reported similar studies.   

     

    Michael P. Dailey, MD, Infectious Disease Services of Georgia, Roswell, GA, Richard C. Prokesch, MD, FACP, FIDSA, Infectious Diseases Associates, Riverdale, GA, John S. Adams, MD, Knoxville Infectious Disease Consultants, P.C., Knoxville, TN, Alfred Bacon, MD, Infectious Disease Associates, PA, Newark, DE and Lucinda J. Van Anglen, PharmD, Healix Infusion Therapy, Inc., Sugar Land, TX

    Disclosures:

    M. P. Dailey, Healix: Contract management services, Contract management services

    R. C. Prokesch, Healix: Business Services management, Business services management

    J. S. Adams, Healix: Contract Managment Services, Contract Management Services

    A. Bacon, Healix: Contract Managment Svcs, Cotract Management Svcs

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