Evaluate the clinical effectiveness of an infectious disease managed outpatient parenteral antibiotic therapy (OPAT) program.
A retrospective chart review of 6120 patients from August 2011 through December 2014 who received OPAT through our program. Patients were either initiated in the hospital (HI) or in the office (OI).
6120 patients were initiated or continued on OPAT for 3 days or longer after evaluation by an infectious disease (ID) specialist. The age of patients ranged from 2-100 years old (average: 59 years). Predominant diagnoses were (Bone/Joint) B/J: 32.2% Abscess: 18.8%, (Skin/Soft Tissue) S/ST: 18.6%, UTI: 10.8%. Most common antibiotics were Ertapenem 26.4%, Ceftriaxone 23.9%, Daptomycin 21.3%, and Vancomycin 21.3%. 864 patients required at least 2 antibiotics concurrently and 606 patients required a change in antibiotic regimen during therapy. Duration of therapy for specific diagnoses: B/BJ: 37.6 days, S/ST: 12.4 days, Abscess: 27.5 days, UTI: 12.6 days. Outcomes were defined as success, modified success, and failure. Modified success was defined as cure with line complications or adverse drug reactions but without hospital admission. Failure was defined as relapse within 30 days of therapy completion or hospitalization due to progression of primary infection or treatment complication.
Failures were seen in 350 patients (5.72%), with 140 relapses (2.29 %), 140 primary infection progressions (2.29 %), and 70 admissions due to therapeutic complications (1.14%). Relapses were more common in OI and primary infection progressions more common in HI patients. Overall cure rates were 94.28%. Total number of patients requiring hospitalization after admission to our program was 210 (3.43%). A transition of care program provided contact with the patient for the month following cessation of therapy.
An ID physician supervised OPAT program continues to be a safe and clinically effective approach to manage patients. With the advent of payment penalties for hospital readmissions, a transition of care program is a critical adjunct. Providing OPAT will continue to be a valuable service for patients, payers, infectious disease physicians, and the healthcare system.
R. Fliegelman, None
D. W. Hines, None
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