Background: Although OPAT is widely accepted practice for adults in the USA, the safety of OPAT in very old patients has not been examined before.
Methods: The Cleveland Clinic OPAT Registry was screened to identify patients aged 90 and above discharged from hospital on OPAT. Control subjects (those aged 89 years and younger) were selected from the OPAT registry, matched to study subjects on sex, year of admission, OPAT site, vascular access, infection category, and antibiotic group. ED visits, readmissions, and deaths, for nonagenarians and controls, were described as competing outcomes. Patients were only included once. Events up to 90 days following initiation of OPAT were considered. OPAT-related ED visits, and separately OPAT-related readmissions, were compared across the two groups in sub-distribution proportional hazards competing risks regression models. Adverse drug events were compared using logistic regression.
Results: 30 nonagenarians and 87 control subjects were identified for patients discharged on OPAT between 2013-01-01 and 2014-05-21. Mean (SD) of age for nonagenarians and controls were 92 (3) and 61 (16), respectively, and 67 (57%) were males. Cardiovascular and osteoarticular infections accounted for more than 50% of infections treated in each group, and the majority of patients received their OPAT in skilled nursing facilities. The cumulative incidences of OPAT-related ED visits and readmissions for nonagenarians and control patients, with death and non-OPAT related readmissions accounted for as competing events, are shown in the figure. Compared to matched patients below 90 years of age, nonagenarians were not at increased risk of OPAT-related ED visits (HR 1.32, 95% CI 0.55-3.18, P 0.54), OPAT-related readmissions (HR 1.2, 95% CI 0.23-6.19, P 0.83), or adverse drug events from OPAT medications (OR 1.22, 95% CI 0.28-8.55, P 0.81).
Conclusion: OPAT can be accomplished in nonagenarians as safely as in younger patients.
S. J. Rehm, None
A. Everett, None
N. Shrestha, None