558. MDR and XDR Tuberculosis: Successes and Complications on OPAT at a London Teaching Hospital between 2009-2016
Session: Poster Abstract Session: Tuberculosis Treatment and Outcome
Thursday, October 27, 2016
Room: Poster Hall
Background: Most MDR and XDR TB treatment regimens require an injectable agent chosen from either capreomycin, amikacin or kanamycin. Given the duration of antibiotics is often over 18 months it is beneficial to administer these injectables on an outpatient parenteral antimicrobial therapy (OPAT) service to improve compliance and reduce lengthy hospital stays. In this retrospective analysis we investigate the success of OPAT in providing the intended duration of antibiotics, the rates and causes of complications.

Methods: Data from a prospectively populated OPAT database were analysed retrospectively. We identified 20 MDR and 5 XDR TB cases over a six year period between 2009-2016. In addition, patient clinical notes were interrogated to complete our data set.

Results: Complication events were experienced in both MDR and XDR TB patient groups with 9/20 (45%) of MDR and 1/5 (20%) of XDR patients requiring readmission during treatment regimens. The complications in the MDR cohort included electrolyte disturbance 12/19 (63%), PICC line complications 3/19 (16%), antibiotic related LFT derangement 1/19 (5%) and non-compliance 1/19 (5%). In the XDR cohort complications were non-compliance 3/5 (60%), PICC line complications 1/5 (20%), and other 1/5 (20%). In the MDR cases 10/20 (50%) experienced one complication, 7/20 (35%) had no complication and the remainder (3/20, 15%) had >1 complication. In the XDR cases 3/5 (60%) experienced one complication, 1/5 (20%) had >1 complication and 1/5 (20%) experienced no complications. The median duration on OPAT was 142 days in MDR and 434 days in XDR TB. OPAT success, defined as completion of the initial intended IV antibiotic duration delivered by OPAT, was seen in 19/20 (95%) MDR and 2/5 (40%) XDR cases. Overall successful completion of treatment, defined as completion of intended oral and IV antibiotics delivered by OPAT and/or other services, was 5/5 (100%) in the XDR cases. In the MDR cases overall successful completion of treatment was 15/16 (94%), excluding 4 cases either transferred abroad or ongoing treatment.

Conclusion: Whilst a high complication and re-admission rate was observed in both MDR and XDR TB these difficult to treat infections can be managed as an outpatient under close supervision with high success rates.

Brama Hanumunthadu, MBBS1, Thomas Harrison, MD2, Deepamol Mathew, BSc1 and Meaghan Cotter, MB BCh1, (1)Microbiology, St.George's Hospital, London, United Kingdom, (2)Infectious Diseases, St.George's Hospital, London, United Kingdom

Disclosures:

B. Hanumunthadu, None

T. Harrison, None

D. Mathew, None

M. Cotter, 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.