1457. Factors associated with failure of Outpatient Parenteral Antibiotic Therapy (OPAT)
Session: Poster Abstract Session: Antimicrobial Stewardship: Outpatient Parenteral Antibiotic Therapy
Saturday, October 10, 2015
Room: Poster Hall
Background: Discharging patients hospitalized with serious bacterial infections to complete treatment with Outpatient Parenteral Antibiotic Therapy (OPAT) has become a popular treatment option.  Despite continue growth of OPAT, there is a paucity of studies investigating OPAT outcomes and factors associated with OPAT failure.  The aim of our study was to describe factors associated with OPAT failure in order to identify patient groups suitable for OPAT and opportunities to improve OPAT use.

Methods: A retrospective, observational cohort study was conducted including all patients discharged from an academic tertiary care hospital on OPAT from March 1, 2014 to February 28, 2015.  Data collection included baseline demographics, antibiotic indication, infecting organism, number and dosing frequency of antibiotics. Clinical outcomes were assessed including; rate of (1) failure (2) re- hospitalization and (3) complications.  Failure was defined as no clinical change or deterioration of infection.

Results: Ninety-eight patients were included in the analysis. The most common indication for OPAT was bone/skin soft tissue infection (38, 38.8%) followed by bacteremia (32, 32.7%).   Among 94 patients with an organism identified, one third had poly-microbial infection.  Twenty-three (23.4%) were discharged with more than one antimicrobial and nearly one-half (46.9%) were discharged with more than once a day antimicrobial dosing.  Close to one third (30.5%) were re admitted.  Eleven patients (12.6%) had failure.  Factors associated with poor clinical outcomes were being discharged with more than one antimicrobial (82.2% vs. 54.5%, p=0.037) and lack of infectious disease follow-up at the time of discharge (49.3% vs. 18.2%, p=0.044). 

Conclusion: A significant number of patients discharged with OPAT service developed complications and were re-hospitalized.  Number of antimicrobials uses and infectious diseases follow up at the time of OPAT arrangement were associated with OPAT outcome.  Our data suggest caution against selecting patients who require more that one antimicrobial for OPAT service.  Also implanting mandatory infectious diseases consults at the time of OPAT arrangement may improve the outcomes.

Sunjit Jaspal, MD1, Marie Dimattia, MD2, Christopher Bruno, MD1 and Dong Heun Lee, MD1, (1)Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA, (2)Division of General Internal Medicine, Drexel University School of Medicine, Philadelphia, PA

Disclosures:

S. Jaspal, None

M. Dimattia, None

C. Bruno, None

D. H. Lee, None

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