Background: POICs offer a controlled setting for safe and effective outpatient treatment of moderate to severe infections with intravenous antimicrobial agents (IVAA) and agents used in treatment of Clostridium difficile infection (CDI). These therapies are provided via in-office or home administration. This study provides an overview of nationwide incidence of outpatient infections and utilization of IVAAs through POICs.
Methods: A retrospective review of our centralized database was conducted of patient (pt) infections and therapy courses provided in POICs nationally that included complete data for 2017. All pts receiving IVAAs and drugs for CDI were included, along with dose, frequency, duration and method of administration. Descriptive measures were used to analyze data.
Results: A total of 12,930 infections were treated in 10,136 pts during 2017 among 77 POICs. Of those, 41% were treated directly from the community setting, avoiding hospitalization. Age distribution was <18 years <1%, 18-65 years 63% and >65 years 36%. Infections comprised 11 major diagnostic groups, with 47 subgroups. The most common diagnoses treated were bone and joint (37%), skin and skin structure (23%), genitourinary (14%) and bacteremia/septicemia (8%). 101 pts (1%) were treated for CDI. Geographical distribution occurred in the Midwest, Northeast, South, and West portion of the US, where diagnoses were similar for all areas except the Northeast. This area had a significantly lower incidence of bone and joint infections (p<0.0001) and a higher incidence of genitourinary infections (p<0.0001). Overall utilization included 52 different agents, with 98.5% antimicrobials, 1% antifungals and 0.5% antivirals. Ceftriaxone was the most frequently used antimicrobial representing 16% of the total use, followed by vancomycin (14.5%), daptomycin (14.2%) and ertapenem (11%). The most prevalent infections and utilization of respective drug therapy is noted in the table.
Conclusion: This study provides an annual overview of outpatient infection incidence with the utilization of IVAAs and therapy for CDI. A wide range of moderate to severe infections were treated, often avoiding hospitalization. Treatment regimens were broad, utilizing a wide variety of drugs and enabling extensive patient management in the POIC setting.
L. J. Van Anglen,
Merck & Co.:
C. P. Schroeder, None