Evaluation of Outpatient Parenteral Antimicrobial Therapy (OPAT) at a Veterans Affairs (VA) Hospital
Background: Outpatient parenteral antimicrobial therapy (OPAT) is the administration of antimicrobial therapy in the home or other non-acute care settings. A growing body of literature suggests OPAT is overused and oversight by antimicrobial stewardship programs (ASPs) can reduce overuse, reduce costs and improve patient safety. Our objective was to define the frequency and characteristics of OPAT use in a large VA medical center. Additionally, we aimed to assess the appropriateness of OPAT use and identify opportunities to improve OPAT use and patient safety.
Methods: We conducted a retrospective chart review of OPAT episodes from January 1, 2012 to December 31, 2012 within the VA Salt Lake City Health System. Each episode was evaluated for drug(s) used, indication, duration of therapy, and if infectious diseases (ID) consultation was obtained. Each episode with and without ID consultation was assessed for appropriateness based on 6 potential modifications: stop therapy; IV to PO conversion; change in duration of therapy; change in drug; reduction in number of drugs; and change in dose. We determined whether a modification would have definitely, possibly or not been recommended for each category.
Results: 193 OPAT episodes occurred in 148 patients. Eighty-one (42%) OPAT episodes were without ID consultation. The most frequently prescribed antimicrobials were vancomycin (34%), carbapenems (26%), 3rd generation cephalosporins (16%), and anti-pseudomonal penicillins (14%). The most common indications for OPAT were bone and joint infections (31%), urinary tract infections (UTIs) (24%) and skin and soft tissue infections (SSTIs) (17%). A definite modification would have been recommended in 35% of cases and a possible modification in 41% of cases. The most commonly recommended changes were IV to PO conversion (30%), change in duration (22%), and change in drug (22%). For 46% of cases, OPAT was potentially not indicated (16% stop, 30% IV to PO).
Conclusion: We found a significant proportion of OPAT use at our institution was potentially avoidable. Misuse of OPAT is common with overuse of broad-spectrum antimicrobials and durations of therapy longer than guideline recommended. An antimicrobial stewardship intervention will likely improve the quality of OPAT use, reduce costs and improve patient safety.
P. Orlando, None
C. Perez, None
M. Samore, None
A. Pavia, None
A. L. Hersh, None
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