838. Outpatient Parenteral Antimicrobial Therapy (OPAT) for Treatment of Complicated Intra-Abdominal Infections
Session: Poster Abstract Session: Clinical Practice Issues
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IAI Poster #838_IDWeek 2013.pdf (1.2 MB)
  • Background:  Optimal treatment of complicated intra-abdominal infections (IAI) requires rapid intervention and initiation of antimicrobial agents.  Infectious Disease (ID) physicians with OPAT services offer a closely supervised setting for community and post-hospital treatment of these patients (pts).  We report clinical experience of pts treated for IAI infections with OPAT in a physician office infusion center (POIC). 

    Methods: A multi-center, retrospective database review of 10 ID POICs was conducted of all pts treated with intravenous antibiotics (IVAB) between January 1 and June 30, 2011.  Data included demographics, co-morbidities, infecting organism, drug therapy, adverse events and outcomes.  Outcomes were defined as cure, improvement requiring oral antibiotics or further surgical intervention or failure due to worsening of infection or recurrence requiring IVAB. 

    Results:  120 pts were identified in 10 POICs, of which 106 (88%) therapy had continued following hospitalization and 14 (12%) had therapy initiated in the POIC.  There were 57 (48%) males and mean age was 56 years.  Predominant IAI infections treated were diverticulitis (34%), abscess (22%), other post-operative abdominal infections (20%) and appendicitis (12%).  Pathogens were reported in 72 pts, with 35 polymicrobial infections.  Predominant organisms included E. coli (21, 18%), Streptococcus spp (15, 13%), and Bacteroides spp (12, 10%). The most commonly utilized IVAB were piperacillin/tazobactam (25%), ertapenem (11%) and ceftriaxone (9%), with a mean length of therapy of 21 days in the OPAT setting.  Cure was reported in 59 (49%) pts and improvement in 45 (38%) pts. 56% of improved cases were discharged with oral therapy and 44% were pending further surgical intervention. 16 (13%) pts failed, 10 of whom had recurrence of infection. A serious adverse event occurred in 1 pt.  The catheter infection rate was 0/1000 catheter days.

    Conclusion: OPAT appears to be a safe and effective setting for treatment of complicated IAI for pts initiated in the POIC as well as those discharged after hospitalization. Overall rates of cure and improvement were high in this population, with low rates of adverse events and catheter-related infections. Further analysis with long-term follow-up is warranted.

    Fernando S. Alvarado, MD, MPH & TM1, Ramesh V. Nathan, MD2, H. Barry Baker, MD, FACP3, Richard L. Levine, MD3, Andrew H. Krinsky, MD4, Richard C. Prokesch, MD, FACP, FIDSA5, Philip Brachman, MD, FACP, FIDSA6 and Lucinda J. Van Anglen, PharmD7, (1)Infectious Disease Consultants, MD, PA, Altamonte Springs, FL, (2)Mazur, Statner, Dutta, Nathan, PC, Thousand Oaks, CA, (3)Infectious Disease Physicians, Miami, FL, (4)Infectious Diseases Associates, Sarasota, FL, (5)Infectious Diseases Associates, Riverdale, GA, (6)Atlanta ID Group, Atlanta, GA, (7)Healix Infusion Therapy, Inc., Sugar Land, TX

    Disclosures:

    F. S. Alvarado, Pfizer: Speaker's Bureau, Speaker honorarium

    R. V. Nathan, Optimer: Speaker's Bureau, Speaker honorarium
    Cubist: Speaker's Bureau, Speaker honorarium

    H. B. Baker, Optimer: Speaker's Bureau, Speaker honorarium
    Cubist: Speaker's Bureau, Speaker honorarium

    R. L. Levine, None

    A. H. Krinsky, None

    R. C. Prokesch, None

    P. Brachman, Gilead: Speaker's Bureau, Speaker honorarium
    Viiv: Speaker's Bureau, Speaker honorarium
    Pfizer: Speaker's Bureau, Speaker honorarium
    Amgen: Speaker's Bureau, Speaker honorarium
    Jansen: Speaker's Bureau, Speaker honorarium

    L. J. Van Anglen, Merck: Investigator, Research grant

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.