The use of outpatient parenteral antimicrobial therapy (OPAT) is expanding, and although a significant proportion of OPAT patients are treated for prosthetic joint infections (PJIs), research on this population is limited. This study examined characteristics associated with 90-day hospital readmission rates for patients receiving OPAT for PJIs.
This retrospective study identified patients who received OPAT for hip and knee PJIs. Inclusion criteria included patients over 18 years who were discharged from 2015-2017 and had follow-up scheduled for OPAT. Patients with a planned readmission or a readmission unrelated to OPAT within 90 days were excluded. The primary outcome of interest was 90-day readmission.
A total of 53 patients were identified. Patient characteristics were as follows: 57% male, 92% Caucasian, median age of 69, median BMI of 32; 34% had diabetes mellitus, and the median Charlson comorbidity score was 4 (IQR 0-5). Fifty-one percent were treated for hip infections and 49% for knee infections. Methicillin-susceptible Staphylococcus aureus PJIs were the most common, accounting for 28% of infections, whereas 6% were treated for methicillin-resistant S. aureus; 36% were discharged to home, 64% to skilled nursing facilities (SNFs); 66% attended their initial OPAT appointment, and the clinic received lab results for safety monitoring in 56% during their first week of OPAT.
A total of 14 (26%) patients were readmitted within 90 days for OPAT-related complications. Of those readmitted, 57% were for worsening infections, 22% for adverse drug events, 14% for vascular access complications, and 7% for Clostridium difficileinfection. None of the patient characteristics were significantly associated with greater readmission risk, and readmission was not associated with a missed initial outpatient appointment or initial safety labs.
Patients discharged on OPAT for PJI are at high risk of readmission. Overall, we found low rates of adherence with initial appointments and safety labs. Most readmissions were due to worsening infection, but it is not clear whether this was related to early hospital discharge, lapses in monitoring, or communication breakdown during transitions of care. More research is warranted in this population at risk for readmission.
E. M. D'Agata, None
J. Adelson-Mitty, None
C. Beckwith, None