1518. Successful Management of Osteomyelitis in Infectious Disease Physician Office Infusion Centers (POICs)
Session: Poster Abstract Session: Clinical Infectious Diseases: Osteomyelitis
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • IDWeek 2015_OSTEO Poster #1518_Adams et al.pdf (600.8 kB)
  • Background:  Outpatient parenteral antibiotic therapy (OPAT) is the standard of care for osteomyelitis (osteo) due to its prolonged treatment with intravenous antibiotics (IVABs). Studies indicate continued high rates of relapse and readmissions. We report management of osteo at an Infectious Disease (ID) POIC.

    Methods:   A multicenter, retrospective review was performed of confirmed osteo patients (pts) with available culture data treated at 10 POICs in 2014. Data included demographics, pathogens, IVAB regimen, adverse events (AEs), and treatment outcomes. Unplanned 30-day hospital admissions and relapses within 6 months of OPAT completion were evaluated and compared to the Healthcare Cost and Utilization Project (HCUP) database and published literature.

    Results:  185 osteo pts, mean age 56 years with 72% males were identified. Predominant locations of osteo included foot in 125 pts (67%), hand/arm/shoulder in 23 pts (12%), vertebra in 15 pts (8%) and leg in 9 pts (5%). Diabetes was a comorbidity in 99 pts (54%). 76 pts (41%) initiated OPAT in the POIC with 21 pts referred from wound care centers, avoiding hospitalization. S. aureus accounted for 66% (n=122) of infections including 63 methicillin-sensitive and 41 methicillin-resistant isolates. Polymicrobial infections were reported in 68 pts (37%). Vancomycin was the most frequently used IVAB (36%) followed by cefazolin (22%) and ceftriaxone (18%) with an overall mean length of OPAT of 39 ± 16 days. 37 pts (20%) received 2 or more IVABs concurrently. Clinical success at the end of OPAT was 92% (n=171) including 42% cured (n=77) and 50% improving (n=94). 8 pts (4%) had an inadequate response to IVAB, and 6 pts were non-evaluable. The majority of pts (62%) had surgical interventions just prior to or during OPAT. 6 pts (3%) were hospitalized during OPAT due to catheter complications or serious AEs. Mild to moderate AEs occurred in 36 pts (19%). The 30-day hospital admissions were 6% compared with 17.3% nationally. Our 6-month relapse rates were 17% as compared with historical data of close to 30%.

    Conclusion: Management of osteo in an ID POIC resulted in a high rate of clinical success following completion of OPAT. The 30 day readmission and relapse rates were low. The closer physician supervision available in a POIC setting likely led to enhanced outcomes, though other factors could also be contributory.

    John S. Adams, MD, FIDSA, FSHEA1, Richard C. Prokesch, MD, FACP, FIDSA2, Robin H. Dretler, MD, FIDSA3, Brian Metzger, MD, MPH4, Quyen Luu, MD5, Andrew H. Krinsky, MD6, Claudia P. Schroeder, PharmD, PhD7 and Lucinda J. Van Anglen, PharmD7, (1)Knoxville Infectious Disease Consultants, P.C., Knoxville, TN, (2)Infectious Diseases Associates, Riverdale, GA, (3)Infectious Disease Specialists of Atlanta, P.C., Decatur, GA, (4)Austin Infectious Disease Consultants, Austin, TX, (5)Quyen Luu, MD, Macon, GA, (6)Infectious Diseases Associates, Sarasota, FL, (7)Healix Infusion Therapy, Inc., Sugar Land, TX

    Disclosures:

    J. S. Adams, None

    R. C. Prokesch, None

    R. H. Dretler, None

    B. Metzger, Cubist/Merck: Speaker's Bureau , Speaker honorarium
    Forest/Actavis: Speaker's Bureau , Speaker honorarium

    Q. Luu, None

    A. H. Krinsky, None

    C. P. Schroeder, None

    L. J. Van Anglen, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.