296. Successful Early Discharge and Avoided Hospitalization for Methicillin-Resistant Staphylococcus Aureus (MRSA) Infections Treated with Outpatient Parenteral Antimicrobial Therapy (OPAT) Result in Healthcare Cost Savings
Session: Poster Abstract Session: HAI: MSSA, MRSA, and other Gram-Positives
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • IDWeek 2016_296_Dretler et al_MRSA.pdf (833.7 kB)
  • Background: MRSA infections cause over $3 billion in annual hospital costs. They were responsible for 48% of hospital-acquired infections in 2014, for which the federal government will penalize hospitals beginning in 2017. Therefore, careful management of MRSA infections by infectious disease (ID) physicians will become crucial in all settings. For those requiring intravenous antibiotics, a physician office infusion center (POIC) may allow for early discharge or avoidance of hospitalization for MRSA patients (pts) with the potential for positive clinical and financial impact.    

    Methods: The study population included all pts from 10 POICs treated with OPAT in 2015 with MRSA recorded as the infecting organism. Demographics, diagnosis, inpatient length of stay (iLOS) prior to OPAT and clinical outcomes were compiled. National mean iLOS by diagnosis was used to compare mean iLOS and avoided hospital days derived from pts in this study. Costs were calculated from iLOS saved and daily hospitalization cost by diagnosis, all obtained from the Healthcare Cost and Utilization Project. Statistical analyses were performed using Students t-test.

    Results: A total of 186 pts (mean age 55 years) were identified including 90 skin/soft tissue (SSTI), 57 bone and joint (BJI), 14 respiratory (Resp), 10 infective endocarditis (IE), 8 central nervous system (CNS) and 7 genitourinary (GU) infections. 127/186 pts (68%) were hospitalized prior to OPAT with 59 pts (32%) avoiding inpatient stay entirely. Of those hospitalized, 77% achieved earlier discharge compared to national averages. In addition to cost savings, 94% of all pts successfully completed OPAT without further intervention other than continued oral antimicrobials. 

    Diagnosis

    Incidence  n (%)

    National Mean iLOS (days)

    Study Mean iLOS (days)

    iLOS Saved (days)

    Cost Savings (USD)

    SSTI

    90 (48)

    4.7

    3.3

    129

    224,537

    BJI

    57 (31)

    7.5

    3.9

    204

    427,715

    Resp

    14 (8)

    7.0

    3.9

    44

    106,212

    IE

    10 (5)

    12.5

    6.9

    92

    254,001

    CNS

    8 (4.3)

    11.6

    6.4

    42

    103,300

    GU

    7 (3.7)

    5.1

    3.3

    13

    26,628

    Summary

    186 (100%)

    8.1

    3.8

    523

    $1,142,395

    Conclusion: Patients with various MRSA infections requiring OPAT experienced earlier hospital discharge or avoidance altogether when managed by ID physicians through a POIC resulting in significant reduction of healthcare costs.

     

    Robin H. Dretler, MD, FIDSA1, Quyen Luu, MD2, Richard C. Prokesch, MD, FACP, FIDSA3, Andrew H. Krinsky, MD4, H. Barry Baker, MD, FACP5, Claudia P. Schroeder, PharmD, PhD6 and Lucinda J. Van Anglen, PharmD6, (1)Infectious Disease Specialists of Atlanta, P.C., Decatur, GA, (2)Quyen Luu, MD, Macon, GA, (3)Infectious Diseases Associates, Riverdale, GA, (4)Infectious Diseases Associates, Sarasota, FL, (5)Infectious Disease Physicians, Miami, FL, (6)Healix Infusion Therapy, Inc., Sugar Land, TX

    Disclosures:

    R. H. Dretler, None

    Q. Luu, None

    R. C. Prokesch, None

    A. H. Krinsky, None

    H. B. Baker, None

    C. P. Schroeder, None

    L. J. Van Anglen, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.