scholarly journals Incidence and risk factors for healthcare utilisation among patients discharged on outpatient parenteral antimicrobial therapy

2018 ◽  
Vol 146 (6) ◽  
pp. 782-787 ◽  
Author(s):  
D. M. Jacobs ◽  
W-Y. Leung ◽  
D. Essi ◽  
W. Park ◽  
A. Shaver ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antimicrobial Therapy ◽  
Healthcare Utilisation ◽  
Risk Groups ◽  
Bivariate Analysis ◽  
Multivariable Logistic Regression Model ◽  
Final Model ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Sepsis Diagnosis ◽  
Multiple Risk Factors

AbstractOutpatient parenteral antimicrobial therapy (OPAT) programmes facilitate hospital discharge, but patients remain at risk of complications and consequent healthcare utilisation (HCU). Here we elucidated the incidence of and risk factors associated with HCU in OPAT patients. This was a retrospective, single-centre, case–control study of adult patients discharged on OPAT. Cases (n = 63) and controls (n = 126) were patients that did or did not utilise the healthcare system within 60 days. Characteristics associated with HCU in bivariate analysis (P ≤ 0.2) were included in a multivariable logistic regression model. Variables were retained in the final model if they were independently (P < 0.05) associated with 60-day HCU. Among all study patients, the mean age was 55 ± 16, 65% were men, and wound infection (22%) and cellulitis (14%) were common diagnoses. The cumulative incidence of 60-day unplanned HCU was 27% with a disproportionately higher incidence in the first 30 days (21%). A statin at discharge (adjusted odds ratios (aOR) 0.23, 95% confidence intervals (CIs) 0.09–0.57), number of prior admissions in past 12 months (aOR 1.48, 95% CIs 1.05–2.10), and a sepsis diagnosis (aOR 4.62, 95% CIs 1.23–17.3) were independently associated with HCU. HCU was most commonly due to non-infection related complications (44%) and worsening primary infection (31%). There are multiple risk factors for HCU in OPAT patients, and formal OPAT clinics may help to risk stratify and target the highest risk groups.

scholarly journals 137. Risk Factors of B-lactams Associated Cytopenias during Outpatient Parenteral Antimicrobial Therapy: Results from a Large National Sample

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S84-S84
Author(s):  
Yasir Hamad ◽  
Katelin B Nickel ◽  
Ige George ◽  
Yvonne J Burnett ◽  
Margaret A Olsen
Keyword(s):  
Risk Factors ◽  
Antimicrobial Therapy ◽  
Lower Risk ◽  
Univariate Analysis ◽  
National Sample ◽  
Beta Lactam ◽  
Beta Lactams ◽  
Multivariable Logistic Regression Model ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Increased Risk

Abstract Background Cytopenias are rare complications of prolonged beta-lactam use; however, incidence and associated risk factors are not well described. Methods Patients aged 18-64 years in the 2010-2016 IBM MarketScan Commercial Database discharged from the hospital on cephalosporin, penicillin, or carbapenem outpatient Parenteral Antimicrobial Therapy (OPAT) were included. The primary endpoint was hospital admission coded for neutropenia, leukopenia, or thrombocytopenia within the first 6 weeks post index discharge and within 7 days of beta-lactam discontinuation. Patients with history of malignancy and those who are on chemotherapy were excluded. Significant factors in univariate analysis were incorporated into a multivariable logistic regression model with sequential exclusion of variables with p &gt; 0.1. Results A total of 35,102 patients received beta-lactam OPAT; median age was 52 years and 53.6% were male. The primary outcome occurred in 150 (0.43%) patients at a median of 19 days (IQR 10-28 days after index discharge), which included 63 (0.18%) neutropenia, 85 (0.24%) thrombocytopenia, and 23 (0.07%) leukopenia admissions. Factors independently associated with readmission cytopenias included chronic liver disease (OR 4.61 [CI 2.93-7.25]), valvular heart disease (2.69 [1.71-4.24]), receipt of vancomycin (2.10 [1.42-3.12]), or antifungal therapy (4.42 [2.01-9.68]); lower risk was associated with carbapenem therapy (0.49 [0.32-0.75]) and diabetes (0.48 [0.31-0.74]) (Table 1). Conclusion Readmissions with cytopenias during beta-lactam OPAT were rare and carbapenem use was associated with lower risk compared to other classes of beta-lactams. Combination of beta-lactam with vancomycin was associated with an increased risk of cytopenias, and those patients might benefit from closer monitoring. Table 1. Factors Associated with Cytopenias during Beta-Lactams Outpatient Parenteral Antimicrobial Therapy (OPAT) Disclosures Margaret A. Olsen, PhD, MPH, Pfizer (Consultant, Research Grant or Support)

scholarly journals Emergency Department Visits During Outpatient Parenteral Antimicrobial Therapy: A Cohort Study

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S333-S334
Author(s):  
So Lim Kim ◽  
Angela Everett ◽  
Susan J Rehm ◽  
Steven Gordon ◽  
Nabin Shrestha
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Hospital Admission ◽  
Vascular Access ◽  
Antimicrobial Therapy ◽  
Cleveland Clinic ◽  
Emergency Department Visits ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Ed Visits ◽  
Access Complications

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) carries risk of vascular access complications, antimicrobial adverse effects, and worsening of infection. Both OPAT-related and unrelated events may lead to emergency department (ED) visits. The purpose of this study was to describe adverse events that result in ED visits and risk factors associated with ED visits during OPAT. Methods OPAT courses between January 1, 2013 and December 31, 2016 at Cleveland Clinic were identified from the institution’s OPAT registry. ED visits within 30 days of OPAT initiation were reviewed. Reasons and potential risk factors for ED visits were sought in the medical record. Results Among 11,440 OPAT courses during the study period, 603 (5%) were associated with 1 or more ED visits within 30 days of OPAT initiation. Mean patient age was 58 years and 57% were males. 379 ED visits (49%) were OPAT-related; the most common visit reason was vascular access complication, which occurred in 211 (56%) of OPAT-related ED visits. The most common vascular access complications were occlusion and dislodgement, which occurred in 99 and 34 patients (47% and 16% of vascular access complications, respectively). In a multivariable logistic regression model, at least one prior ED visit in the preceding year (prior ED visit) was most strongly associated with one or more ED visits during an OPAT course (OR 2.96, 95% CI 2.38 – 3.71, p-value &lt; 0.001). Other significant factors were younger age (p 0.01), female sex (p 0.01), home county residence (P &lt; 0.001), and having a PICC (p 0.05). 549 ED visits (71%) resulted in discharge from the ED within 24 hours, 18 (2%) left against medical advice, 46 (6%) were observed up to 24 hours, and 150 ED visits (20%) led to hospital admission. Prior ED visit was not associated with hospital admission among patients who visited the ED during OPAT. Conclusion OPAT-related ED visits are most often due to vascular access complications, especially line occlusions. Patients with a prior ED visit in the preceding year have a 3-fold higher odds of at least one ED visit during OPAT compared with patients without a prior ED visit. A strategy of managing occlusions at home and a focus on patients with prior ED visits could potentially prevent a substantial proportion of OPAT-related ED visits. Disclosures All authors: No reported disclosures.

scholarly journals Risk Factors For Readmission Among Patients Receiving Outpatient Parenteral Antimicrobial Therapy; A Retrospective Cohort Study

2021 ◽  
Author(s):  
Sabrine Douiyeb ◽  
Jara R. de la Court ◽  
Bram Tuinte ◽  
Ferdi Sombogaard ◽  
Rogier P. Schade ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Therapeutic Drug Monitoring ◽  
Antimicrobial Therapy ◽  
Drug Monitoring ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Prosthetic Material ◽  
Therapeutic Drug ◽  
Outpatient Parenteral Antimicrobial Therapy

Abstract Background: In the Netherlands, home treatment with intravenous antimicrobial therapy is a relatively new concept. Although several studies have shown that outpatient parenteral antimicrobial therapy (OPAT) can be administered safely, people receiving antimicrobials at home remain at risk for adverse events, including readmission.Objectives: The aim of our retrospective study is to identify risk factors for readmission in patients discharged with OPAT.Method: Retrospective cohort study during a period of January 2016 - December 2018. Patients, age > 18 years, discharged with OPAT were included. Variables collected consisted of baseline demographics, complications, readmission within 30 days and treatment failure. Multivariate logistic regression analysis was performed to identify risk factors for readmission.Results: A total of 247 patients were included; the most common reason for OPAT was bone and joint infections (17%). Penicillin (37%), cephalosporin (26%) and vancomycin/aminoglycoside (15%) were the most commonly prescribed antimicrobials. Among the patients receiving medication subject to therapeutic drug monitoring (i.e. aminoglycosides or vancomycin), 51% (19/37) received weekly therapeutic drug monitoring. Receiving aminoglycosides or vancomycin (adjusted OR: 2.05; 95% CI, 1.30-3.25, p<0.05) and infection of prosthetic material (adjusted OR: 2.92, 95% CI, 1.11-7.65, p<0.05) were independent risk factors for readmission. Conclusion: Although patients receiving medication subject to therapeutic drug monitoring are at higher risk of readmission, only half of the patients discharged with aminoglycosides or vancomycin were monitored according to IDSA guidelines. A specialized team in charge of monitoring OPAT-patients is likely to increase the rate of monitoring to prevent readmissions and complications.

scholarly journals Rates of and Risk Factors for Adverse Drug Events in Outpatient Parenteral Antimicrobial Therapy

2017 ◽  
Vol 66 (1) ◽  
pp. 11-19 ◽  
Author(s):  
Sara C Keller ◽  
Deborah Williams ◽  
Mitra Gavgani ◽  
David Hirsch ◽  
John Adamovich ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antimicrobial Therapy ◽  
Adverse Drug Events ◽  
Outpatient Parenteral Antimicrobial Therapy

Risk factors for catheter related thrombosis during outpatient parenteral antimicrobial therapy

2021 ◽  
pp. 112972982110093
Author(s):  
Paul R Ingram ◽  
Sinead Kilgarriff ◽  
Michael Grzelak ◽  
Gavin Jackson ◽  
Peter Carr ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antimicrobial Therapy ◽  
Retrospective Case ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Related Risk ◽  
Reduction Strategies ◽  
Tertiary Hospitals ◽  
Catheter Tip ◽  
Clinically Significant ◽  
Catheter Related Thrombosis

Background: Outpatient parenteral antimicrobial therapy (OPAT) delivery using peripherally inserted central catheters is associated with a risk of catheter related thrombosis (CRT). Individualised preventative interventions may reduce this occurrence, however patient selection is hampered by a lack of understanding of risk factors. We aimed to identify patient, infection or treatment related risk factors for CRT in the OPAT setting. Methods: Retrospective case control study (1:3 matching) within OPAT services at two tertiary hospitals within Australia. Results: Over a 2 year period, encompassing OPAT delivery to 1803 patients, there were 19 cases of CRT, giving a prevalence of 1.1% and incidence of 0.58/1000 catheter days. Amongst the cases of CRT, there were nine (47%) unplanned readmissions and two (11%) pulmonary emboli. Compared to controls, cases had a higher frequency of malposition of the catheter tip (4/19 (21%) vs 0/57 (0%), p = 0.003) and complicated catheter insertion (3/19 (16%) vs 1/57 (2%), p = 0.046). Conclusions: Although CRTs during OPAT are infrequent, they often have clinically significant sequelae. Identification of modifiable vascular access related predictors of CRT should assist with patient risk stratification and guide risk reduction strategies.

Risk factors for amendment in type, duration and setting of prescribed outpatient parenteral antimicrobial therapy (OPAT) for adult patients with cellulitis: a retrospective cohort study and CART analysis

2017 ◽  
Vol 94 (1107) ◽  
pp. 25-31 ◽  
Author(s):  
Michael Quirke ◽  
Emma May Curran ◽  
Patrick O’Kelly ◽  
Ruth Moran ◽  
Eimear Daly ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Cohort Study ◽  
Antimicrobial Therapy ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Adult Patients ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Cart Analysis ◽  
Cart Algorithm

Purpose of the studyTo measure the percentage rate and risk factors for amendment in the type, duration and setting of outpatient parenteral antimicrobial therapy (OPAT) for the treatment of cellulitis.Study designA retrospective cohort study of adult patients receiving OPAT for cellulitis was performed. Treatment amendment (TA) was defined as hospital admission or change in antibiotic therapy in order to achieve clinical response. Multivariable logistic regression (MVLR) and classification and regression tree (CART) analysis were performed.ResultsThere were 307 patients enrolled. TA occurred in 36 patients (11.7%). Significant risk factors for TA on MVLR were increased age, increased Numerical Pain Scale Score (NPSS) and immunocompromise. The median OPAT duration was 7 days. Increased age, heart rate and C reactive protein were associated with treatment prolongation. CART analysis selected age <64.5 years, female gender and NPSS <2.5 in the final model, generating a low-sensitivity (27.8%), high-specificity (97.1%) decision tree.ConclusionsIncreased age, NPSS and immunocompromise were associated with OPAT amendment. These identified risk factors can be used to support an evidence-based approach to patient selection for OPAT in cellulitis. The CART algorithm has good specificity but lacks sensitivity and is shown to be inferior in this study to logistic regression modelling.

Identification of hospitalized patients with community-acquired infection in whom treatment guidelines do not apply: a validated model

2019 ◽  
Vol 75 (4) ◽  
pp. 1047-1053
Author(s):  
Teresa Cardoso ◽  
Pedro Pereira Rodrigues ◽  
Cristina Nunes ◽  
Mónica Almeida ◽  
Joana Cancela ◽  
...  
Keyword(s):  
Risk Factors ◽  
Functional Impairment ◽  
Antimicrobial Therapy ◽  
Validation Cohort ◽  
Treatment Guidelines ◽  
Invasive Procedures ◽  
Operating Characteristics ◽  
Final Model ◽  
Associate Risk ◽  
Community Acquired Infection

Abstract Objectives To develop and validate a clinical model to identify patients admitted to hospital with community-acquired infection (CAI) caused by pathogens resistant to antimicrobials recommended in current CAI treatment guidelines. Methods International prospective cohort study of consecutive patients admitted with bacterial infection. Logistic regression was used to associate risk factors with infection by a resistant organism. The final model was validated in an independent cohort. Results There were 527 patients in the derivation and 89 in the validation cohort. Independent risk factors identified were: atherosclerosis with functional impairment (Karnofsky index &lt;70) [adjusted OR (aOR) (95% CI) = 2.19 (1.41–3.40)]; previous invasive procedures [adjusted OR (95% CI) = 1.98 (1.28–3.05)]; previous colonization with an MDR organism (MDRO) [aOR (95% CI) = 2.67 (1.48–4.81)]; and previous antimicrobial therapy [aOR (95% CI) = 2.81 (1.81–4.38)]. The area under the receiver operating characteristics (AU-ROC) curve (95% CI) for the final model was 0.75 (0.70–0.79). For a predicted probability ≥22% the sensitivity of the model was 82%, with a negative predictive value of 85%. In the validation cohort the sensitivity of the model was 96%. Using this model, unnecessary broad-spectrum therapy would be recommended in 30% of cases whereas undertreatment would occur in only 6% of cases. Conclusions For patients hospitalized with CAI and none of the following risk factors: atherosclerosis with functional impairment; previous invasive procedures; antimicrobial therapy; or MDRO colonization, CAI guidelines can safely be applied. Whereas, for those with some of these risk factors, particularly if more than one, alternative antimicrobial regimens should be considered.

scholarly journals Risk Factors for Readmission in Patients with Outpatient Parenteral Antimicrobial Therapy

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S334-S334 ◽  
Author(s):  
Victoria Huang ◽  
Polina Lerner ◽  
Jorg Ruhe ◽  
Marianna Fedorenko
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Antimicrobial Therapy ◽  
Skilled Nursing Facility ◽  
Significant Risk ◽  
Organ Damage ◽  
Chronic Obstructive ◽  
Regression Analyses ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Picc Line

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) is a practical and effective way of delivering antimicrobial therapy, but may be associated with significant risk for hospital readmission. This study aimed to elucidate risk factors related to 30-day readmissions in patients who were discharged with OPAT at Mount Sinai Beth Israel (MSBI). Methods This IRB approved retrospective cohort study included patients who were at least 18 years or older, admitted to MSBI from August 2015 to March 2016, and discharged to receive OPAT. Subjects were identified using the vascular access team’s monthly reports of peripherally inserted central catheter (PICC) and midline insertion; there was no standardized OPAT program at MSBI. Patients with intravenous antibiotics prescribed for chronic suppression or planned readmission within 30 days were excluded. Information on baseline demographic, clinical, and treatment parameters were collected. The main outcome was readmission to the hospital within 30 days from previous hospital discharge. Univariate and logistic regression analyses were performed to determine predictors of 30-day readmission. Results There were a total of 200 patients included in the analysis; the median age was 60 years, 66% were male, and the median Charlson score was 2. Diabetes, peripheral vascular disease, and chronic obstructive pulmonary disease were the most common comorbidities. A total of 155 (78%) patients received a PICC line; the remainder was discharged with a midline. The most common medications prescribed for OPAT included cephalosporins (41%), vancomycin (31%), carbapenems (23%), and penicillins (16%). A total of 42 patients (21%) were readmitted within 30 days after previous discharge. Independent predictors of readmission on logistic regression analyses were (P &lt; 0.05): discharge to a skilled nursing facility or subacute rehabilitation center, diabetes without end-organ damage, and PICC line usage. Conclusion Readmissions are common in patients discharged with OPAT. Recognizing predictors of readmission may help determine strategies to optimize care. Disclosures All authors: No reported disclosures.

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