1463. Experience and Outcomes After a Year of Implementation of a Program for Outpatient Parenteral Antimicrobial Therapy in a Tertiary Care Hospital in Mexico City
Session: Poster Abstract Session: Antimicrobial Stewardship: Outpatient Parenteral Antibiotic Therapy
Saturday, October 10, 2015
Room: Poster Hall
Background: In developed countries, outpatient parenteral antimicrobial therapy (OPAT) lowers costs and in-hospital stay. There is scant information in developing countries, where OPAT could perform differently.

During 2014, due to a high local prevalence of microorganisms with extended spectrum beta-lactamases (ESBL), we decided to implement a clinic for OPAT to administer ertapenem in our facility. The objective of this study is to describe the clinical characteristics and outcome during the first year of operation of this program.

Methods: We included all patients who received OPAT during a period of one year. Patients with diagnosis of an infection at any site that in the opinion of the treating physician required hospitalization only for antibiotic IV administration and hemodynamically stable for outpatient care.

Results: We analyzed 248 patients, mean age 51.5 ± 18.5 years; 163 (66%) women. OPAT duration was 8 ± 6.7 days. The main causes of admission were urinary tract infections (UTI) (230 patients, 93%) and intra-abdominal infection (IAI) (9 cases, 4%); 102 patients were immunocompromised (37 due to autoimmune disease, 46 with solid organ transplant and 19 due to chemotherapy for cancer). Positive cultures from 219 patients were seen, the most frequent were  Escherichia coli (186, 75%) and other gram-negative rods in 58 (23%); 153 (62%) isolates were ESBL producers.

A month after OPAT, 174 patients were cured (70%), 10 patients with UTI had persistant bacteriuria (4%) and 50 more recurrence (22%), 14 additional cases were hospitalized because diverse reasons independent from the original diagnosis.  

There were adverse events in 15 patients (phlebitis in 6, adverse drug reaction in 8, and catheter entry site infection in 1) none considered severe.

Thirteen patients abandoned the OPAT clinic but only in 7 of them we ignore the actual clinical status.

After OPAT, from 241 patients who complete the follow-up (1 month) 4 patients died; two due to cancer complications and two due to different infections (pneumonia and cholangitis in patients who had been admitted because of an UTI). 

Conclusion: Our results shows good patient-based outcomes and a low rate of complications of an OPAT program -even a high prevalence of ESBL+ organisms- in a low resource country.

Erika Faride Rodriguez Aguilar, MD1, Yemil Atisha-Fregoso, MD1, Alfredo Ponce De Leon-Garduño, MD2 and José Sifuentes-Osornio, MD, FIDSA3, (1)Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Mexico, (2)Clinical Microbiology Laboratory, Natl. Inst. of Medical Sci. and Nutrition Salvador Zubirán, Mexico City, Mexico, (3)Clinical Microbiology Laboratory, Instituto, Mexico City, Mexico

Disclosures:

E. F. Rodriguez Aguilar, None

Y. Atisha-Fregoso, None

A. Ponce De Leon-Garduño, Pfizer: Board Member and Scientific Advisor , Grant recipient
MSD: Board Member , Grant recipient
Jannsen-Cilag: Scientific Advisor , Speaker honorarium

J. Sifuentes-Osornio, None

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