1927. Preference for Intravenous Versus Oral Antibiotics at Hospital Discharge
Session: Poster Abstract Session: Clinical Practice Issues: HIV, Sepsis, QI, Diagnosis
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • 1927_IDWPOSTER.pdf (965.8 kB)
  • Background:

    This pilot study analyzes decisions of infectious diseases faculty: hospital discharge with oral versus intravenous antibiotics in the context of an academic OPAT (outpatient parenteral antibiotic therapy) system.

    Methods:

    We created a survey of 8 patient scenarios culled from the OPAT records of Tufts Medical Center. Six case scenarios had clinical equipoise, while 2 control scenarios had a clear indication for discharge with intravenous antibiotics. Infectious diseases attendings affiliated with Tufts Medical Center were surveyed. Respondents were asked preferences for oral versus intravenous antibiotics for each scenario, their confidence in each decision, and demographics. Providers’ antibiotic scores equaled the sum of responses to the 6 case scenarios (1 point for intravenous, 0 points for oral). Self-assessments of confidence in each decision were on a scale of 0 to 100% (100% indicating complete confidence).

    Results:

    Nine of thirty responded to the survey. All reported US-based training/experience. All indicated preference for intravenous antibiotics in the 2 control scenarios. The average antibiotic score for all providers was 2.9. Factors trended with choosing oral antibiotics: ≤5 years of experience and > 12 weeks of inpatient service per year.

    All

    OPAT providers

    N=6

    Non OPAT providers

    N=3

    =< 5 years' experience N=3

    >5 years' experience N=6

    =< 12 weeks inpatient

    N=6

    > 12 weeks inpatient

    N= 3

    Average antibiotic score

    2.9

    2.8

    3

    2

    3.3

    3.3

    2

    Average confidence level %

    72

    72

    73

    64

    76

    71

    74

    “OPAT providers” = MDs who see OPAT patients as outpatients.

    Conclusion:

    Although in reality all six case scenario patients had been discharged on intravenous antibiotics, respondents chose oral antibiotics almost 50% of the time. This pilot study demonstrates potential for antibiotic stewardship regarding intravenous recommendations.

    Anthony Karabanow, MD, Geneve Allison, MD, MSc and Shira Doron, MD, MS, FIDSA, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA

    Disclosures:

    A. Karabanow, None

    G. Allison, None

    S. Doron, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.