Evaluate the treatment failures seen in an infectious disease (ID) managed outpatient parenteral antibiotic therapy (OPAT) program.
A retrospective chart review of 350 patients from August 2011 through December 2014 who received OPAT and failed therapy. Patients were either initiated in the hospital (HI) or the office (OI).
350 of 6120 (5.7%) patients who were initiated on OPAT for 3 days or longer after evaluation by an ID specialist ended in therapy failure. Failure was defined as relapse of primary infection within 30 days of therapy completion, hospitalization due to progression of primary infection or treatment complication. Most common diagnoses in patients who failed were (Bone/Joint) B/J: 37.7% Abscess: 18%, (Skin/Soft Structure) S/ST: 14.9%, and UTI: 13.4%. Initial therapies were: Daptomycin 24%, Ertapenem 20.9%, Vancomycin 20%, and Ceftriaxone 16%. Patients that were 65 and older failed at a rate of 6.4%, ages 19-64 years: 5.4%, and ages 18 and under: 1.1%. Patients with diabetes as a comorbid condition failed at a 7.5% rate versus 5.2% for patients not diabetic. No diagnosis or initial therapy was a predictor of failure. Patients that were OI were more likely to suffer a relapse within 30 days (56.4%) and those HI were more likely to be admitted with progression of primary infection (47.8%).
A transition of care program provided clinical contact with patients after OPAT was completed to minimize hospital admissions by identifying patients at risk for failure.
Patients were successfully treated with OPAT over 94% of the time. Diabetes was a suggestive variable for failure. Further studies identifying confounding variables such as prior admission or antibiotic therapy should provide guidance to determine a patient’s potential risk of failure at entry into an OPAT program.
D. W. Hines, None
R. Fliegelman, None
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