scholarly journals 609. Implementation and Post-implementation Analysis of a Pilot Program for Inpatient Review of Outpatient Parenteral Antimicrobial Therapy Prior to Discharge

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S365-S366
Author(s):  
Delaney Hart ◽  
Hailey McCoy ◽  
Krista Gens ◽  
Michael Wankum ◽  
Andrew Tarleton
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Therapy ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Time Frame ◽  
Blood Stream ◽  
Central Line ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Chi Squared

Abstract Background The Infectious Diseases Society of America OPAT (outpatient parenteral antimicrobial therapy) guidelines state that effective OPAT programs require a multidisciplinary team1. Currently within the health system, there is no formal OPAT program in place, and OPAT prescribing is not limited to any specialty. This project aimed to pilot a pharmacist-driven program across five hospitals. Methods Adult patients with OPAT ordered between February 1 and May 1, 2020 were included. Patients were excluded if the OPAT was prescribed by infectious diseases (ID) providers or if patients were on OPAT prior to hospital admission. An alert was generated in the electronic health record (EHR) when an order for an intravenous catheter was placed for patients with concomitant antimicrobials. Follow up was performed and documented via a progress note in the EHR as appropriate. Data was collected via retrospective chart review and statistical analysis was performed using Chi-squared test with Yates’ correction. Results 101 pre- and 7 patients post-implementation were included in this study. There were a total of 51 patients pre-implementation that received inappropriate OPAT care per the IDSA OPAT guidelines, and post-implementation 2 patients (50.5% vs 28.6%, p=0.47). The secondary outcomes of 30-day readmission rates were 17% and 0% (p=0.52); and complications related to OPAT (e.g. central-line associated blood stream infections) were 12% and 0% (p=0.73), respectively. 2 midline catheters were recommended by the OPAT team, and a cost savings of up to $6,796 was calculated. Conclusion This pilot showed a trend towards decreased inappropriate OPAT prescribing and cost avoidance of an ID pharmacist-driven review of OPAT prior to patient hospital discharge. Limitations to this pilot included being underpowered due to the limited time-frame of the post-implementation period, and an inability for follow up with patients discharged utilizing an alternative home infusion service. Disclosures All Authors: No reported disclosures

scholarly journals Patient Characteristics and Outcomes of Outpatient Parenteral Antimicrobial Therapy: A Retrospective Study

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Marie Yan ◽  
Marion Elligsen ◽  
Andrew E. Simor ◽  
Nick Daneman
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Therapy ◽  
Retrospective Chart Review ◽  
Surgical Site Infections ◽  
Patient Characteristics ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Health Care Encounters ◽  
One Year ◽  
Alternative To Hospitalization

Outpatient parenteral antimicrobial therapy (OPAT) is a safe and effective alternative to hospitalization for many patients with infectious diseases. The objective of this study was to describe the OPAT experience at a Canadian tertiary academic centre in the absence of a formal OPAT program. This was achieved through a retrospective chart review of OPAT patients discharged from Sunnybrook Health Sciences Centre within a one-year period. Between June 2012 and May 2013, 104 patients (median age 63 years) were discharged home with parenteral antimicrobials. The most commonly treated syndromes included surgical site infections (33%), osteoarticular infections (28%), and bacteremia (21%). The most frequently prescribed antimicrobials were ceftriaxone (21%) and cefazolin (20%). Only 56% of the patients received follow-up care from an infectious diseases specialist. In the 60 days following discharge, 43% of the patients returned to the emergency department, while 26% required readmission. Forty-eight percent of the return visits were due to infection relapse or treatment failure, and 23% could be attributed to OPAT-related complications. These results suggest that many OPAT patients have unplanned health care encounters because of issues related to their infection or treatment, and the creation of a formal OPAT clinic may help improve outcomes.

scholarly journals 597. Comparison of Vancomycin and Daptomycin Complications and Interventions in Outpatient Parenteral Antimicrobial Therapy

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S361-S362
Author(s):  
Monark Nakrani ◽  
Diana Yu ◽  
Monica Sikka ◽  
James Lewis ◽  
Alyse Douglass ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Hospital Readmissions ◽  
Skilled Nursing Facility ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Phone Calls ◽  
Ed Visits ◽  
The Difference ◽  
Vancomycin Group

Abstract Background Vancomycin and daptomycin are commonly used in outpatient parenteral antimicrobial therapy (OPAT) for patients requiring lengthy courses of intravenous antimicrobials who are otherwise stable for discharge. Balancing the convenience and cost-savings of OPAT with the potential for adverse effects is challenging, this study compared the rates of complications and antimicrobial interventions for patients receiving vancomycin versus daptomycin across multiple OPAT settings. Methods We performed a retrospective chart review of adult OPAT patients who received >72 hours of vancomycin or daptomycin via home infusion, infusion center, or skilled nursing facility between January 2017 and August 2019. The outcomes evaluated included the rates of adverse drug reactions (ADRs), laboratory results above a defined threshold (vancomycin levels >20 mg/mL in the vancomycin arm and creatinine phosphokinase (CPK) levels >500 units/L in the daptomycin group), line complications, emergency department (ED) visits, and hospital readmissions. Other outcomes included additional phone calls and interventions required to coordinate care (additional labs, assessment of symptoms, additional test or antimicrobial-related dose changes) by the OPAT team. Results 180 patients were included; 130 received vancomycin and 50 received daptomycin. (Table 1) Patients in the vancomycin group had more supratherapeutic vancomycin troughs than elevated CPK for patients in the daptomycin group (rate ratio [RR] 0.16, 95% CI 0.05-0.50, p=0.0018). Rates of interventions (RR 0.37, 95% CI 0.26-0.52, p< 0.0001) and additional phone calls (RR 0.56, 95% CI 0.43-0.72, p< 0.0001) were also higher for patients in the vancomycin group. There were no statistically significant differences between groups in the rates of ADRs, line complications, ED visits, or hospital readmissions. (Table 2) Table 1. Baseline Characteristics Table 2. Outcomes Conclusion Vancomycin-treated patients had significantly more laboratory abnormalities and required significantly more time in patient care coordination by the OPAT team. The difference in healthcare utilization between these groups suggests a potential for significant cost-savings for OPAT patients and the healthcare system. Disclosures All Authors: No reported disclosures

scholarly journals 774. A New Outpatient Parenteral Antimicrobial Therapy (OPAT) Management Program Reduces Excess Antimicrobial Days of Therapy and Expedites Timely Central Line Removal

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S344-S344
Author(s):  
Catherine Kidd ◽  
Joshua C Eby ◽  
Tania Thomas ◽  
Megan Shah ◽  
Zachary Elliott ◽  
...  
Keyword(s):  
Retrospective Chart Review ◽  
Bloodstream Infections ◽  
Central Line ◽  
Management Program ◽  
Close Attention ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Days Of Therapy ◽  
The Difference ◽  
The Impact

Abstract Background Patients discharged on parenteral antimicrobials often require in-person follow-up to determine antimicrobial discontinuation and coordination of central line (CL) removal at the end of therapy. Without close attention to timing of follow-up, antimicrobial courses may be extended beyond a planned end date until scheduled follow-up, leading to excess antimicrobial days of therapy (DOT) and CL retention. Excess DOT can result in increased cost of medication and CL supplies, antimicrobial exposure, and risk of CL-associated bloodstream infections or thrombosis. We sought to assess the impact of the University of Virginia (UVA) OPAT program on excess antimicrobial DOT and excess CL days. Methods This was a retrospective chart review of patients enrolled in the OPAT program at UVA between August 2018 and April 2019. The UVA OPAT program was started in August 2018. Quality improvement (QI) practice changes were implemented in February 2019 for improving follow-up and stopping antimicrobials at the projected end date. Patients were therefore divided into 2 cohorts – August through January 2018 and February through April 2019. Data collected included projected end date of therapy (EOT), actual EOT, actual removal date of CL, and follow-up date. Excess antimicrobial DOT and excess CL days were calculated by the difference in projected vs. actual dates. For continuous data, Student t-test was used. Results 248 patients enrolled in OPAT from August 2018 through April 2019. After implementation of QI efforts, mean time from projected EOT to follow-up appointment decreased from 10.0 days to 4.3 days for those with appointments after projected EOT. Mean excess antimicrobial DOT decreased from 2.8 ± 4.53 SD days to 1.6 ± 2.75 SD days (P = 0.026), and mean excess CL days decreased from 3.2 ± 4.63 SD days to 2.0 ± 2.89 SD days (P = 0.035). Conclusion The involvement of an OPAT program with close attention to outpatient follow-up and cessation of antimicrobials decreased the excess antimicrobial DOT and CL days and reduced variability in care. Reduction in antimicrobial overuse and CL overuse is expected to reduce cost and decrease the risk of medication- and CL-related collateral damage. Disclosures All authors: No reported disclosures.

2018 Infectious Diseases Society of America Clinical Practice Guideline for the Management of Outpatient Parenteral Antimicrobial Therapya

2018 ◽  
Vol 68 (1) ◽  
pp. 1-4 ◽  
Author(s):  
Anne H Norris ◽  
Nabin K Shrestha ◽  
Genève M Allison ◽  
Sara C Keller ◽  
Kavita P Bhavan ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Healthcare Professionals ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Infusion Catheter

Abstract A panel of experts was convened by the Infectious Diseases Society of America to update the 2004 clinical practice guideline on outpatient parenteral antimicrobial therapy (OPAT) [1]. This guideline is intended to provide insight for healthcare professionals who prescribe and oversee the provision of OPAT. It considers various patient features, infusion catheter issues, monitoring questions, and antimicrobial stewardship concerns. It does not offer recommendations on the treatment of specific infections. The reader is referred to disease- or organism-specific guidelines for such support.

Close Patient Follow-up Among Patients Receiving Outpatient Parenteral Antimicrobial Therapy

2019 ◽  
Vol 70 (1) ◽  
pp. 67-74 ◽  
Author(s):  
Danielle L Palms ◽  
Jesse T Jacob
Keyword(s):  
Logistic Regression ◽  
Antimicrobial Therapy ◽  
Care Transitions ◽  
Clinic Visit ◽  
Outpatient Setting ◽  
Multivariate Logistic Regression Model ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Charlson Comorbidity Score ◽  
Pathogen Diagnosis

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) programs allow patients to receive intravenous treatment in the outpatient setting. We developed a predictive model of 30-day readmission among hospitalized patients discharged on OPAT from 2 academic medical centers with a dedicated OPAT clinic for management. Methods A retrospective medical records review was performed and logistic regression was used to assess OPAT and other outpatient clinic follow-up in conjunction with age, sex, pathogen, diagnosis, discharge medication, planned length of therapy, and Charlson comorbidity score. We hypothesized that at least 1 follow-up visit at the Emory OPAT clinic would reduce the risk for hospital readmission within 30 days. Results Among 755 patients, 137 (18%) were readmitted within 30 days. Most patients (73%) received outpatient follow-up care at Emory Healthcare within 30 days of discharge or prior to readmission, including 52% of patients visiting the OPAT clinic. The multivariate logistic regression model indicated that a follow-up OPAT clinic visit was associated with lower readmission compared to those who had no follow-up visit (odds ratio, 0.10 [95% confidence interval, .06–.17]) after adjusting for infection with enterococci, Charlson score, discharge location, and county of residence. Conclusions These results can inform potential interventions to prevent readmissions through OPAT clinic follow-up and to further assess factors associated with successful care transitions from the inpatient to outpatient setting.

scholarly journals Combined Topical and Oral Antimicrobial Therapy for the Eradication of Methicillin-ResistantStaphylococcus aureus(Mrsa) Colonization in Hospitalized Patients

2002 ◽  
Vol 13 (5) ◽  
pp. 287-292 ◽  
Author(s):  
Scott K Fung ◽  
Marie Louie ◽  
Andrew E Simor
Keyword(s):  
Medical Devices ◽  
Antimicrobial Therapy ◽  
Chart Review ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Hospitalized Patients ◽  
Urinary Catheters ◽  
Mupirocin Ointment ◽  
Mrsa Colonization

OBJECTIVE: How to eradicate methicillin-resistantStaphylo-coccus aureus(MRSA) colonization in hospitalized patients is uncertain. We reviewed our experience with MRSA decolonization therapy in hospitalized patients.SETTING: An 1100-bed, university-affiliated tertiary care teaching hospital in Toronto, Ontario.DESIGN: Retrospective chart review of 207 adult inpatients with MRSA colonization hospitalized between February 1996 and March 1999.INTERVENTIONS: All patients with MRSA colonization were assessed for possible decolonization therapy with a combination of 4% chlorhexidine soap for bathing and washing, 2% mupirocin ointment applied to the anterior nares three times/day, rifampin (300 mg twice daily) and either trimethoprim/sulfamethoxazole (160 mg/800 mg twice daily) or doxycycline (100 mg twice daily). This treatment was given for seven days.RESULTS: A total of 207 hospitalized patients with MRSA colonization were identified and 103 (50%) received decolonization therapy. Patients who received decolonization therapy were less likely than untreated patientsto have intravenous (P=0.004) or urinary catheters (P<0.001), or extranasal sites of colonization (P=0.001). Successful decolonization was achieved in 90% of the 43 patients who were available for at least three months of follow-up.CONCLUSIONS: Combined topical and oral antimicrobial therapy was found to be effective in eradicating MRSA colonization in selected hospitalized patients, especially those without indwelling medical devices or extranasal sites of colonization.

On- and off-label utilization of dalbavancin and oritavancin for Gram-positive infections

2019 ◽  
Vol 74 (8) ◽  
pp. 2405-2416 ◽  
Author(s):  
Taylor Morrisette ◽  
Matthew A Miller ◽  
Brian T Montague ◽  
Gerard R Barber ◽  
R Brett McQueen ◽  
...  
Keyword(s):  
Health System ◽  
Injection Drug Users ◽  
Drug Users ◽  
Cost Savings ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Gram Positive ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Off Label

AbstractBackgroundLong-acting lipoglycopeptides (laLGPs) are FDA approved only for acute bacterial skin and skin structure infections (ABSSSIs). However, these antibiotics show promise for off-label use, reductions in hospital length of stay (LOS) and healthcare cost savings.ObjectivesTo assess the effectiveness, safety, impact on LOS and estimated cost savings from laLGP treatment for Gram-positive infections.MethodsRetrospective cohort of adult patients who received at least one dose of laLGPs at the University of Colorado Health system. Descriptive statistics were utilized for analysis.ResultsOf 59 patients screened, 56 were included: mean age 47 years, 59% male and 30% injection drug users/polysubstance abusers (dalbavancin, 71%; oritavancin, 25%; both, 4%). Most common indications for laLGP: ABSSSIs (36%), osteomyelitis (27%) and endocarditis (9%). Most common isolated pathogens: MSSA and MRSA (25% and 19%, respectively), Enterococcus faecalis (11%) and CoNS (11%). Previous antibiotics were administered for a median of 13 days (IQR = 7.0–24.5 days) and laLGPs for a median of one dose (IQR = 1–2 doses). Ten (18%) patients were lost to follow-up. Clinical failure was found in 7/47 (15%) cases with adequate follow-up. Mild adverse effects occurred in six (11%) patients. Projected reduction in hospital LOS and health-system costs were 514 days (9.18 days/person average) and $963456.72 ($17204.58/person average), respectively.ConclusionsProspective trials are needed to validate the use of these antibiotics for Gram-positive infections in practice, with the hope that they will reduce hospital LOS and the need for daily antibiotic infusions to provide alternative options for patients not qualifying for outpatient parenteral antimicrobial therapy.

scholarly journals 1134. Substance Use Disorder Patients’ Perspectives of a Multidisciplinary Antimicrobial Infusion Service

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S596-S596
Author(s):  
Joy J Juskowich ◽  
Clinton G Cooper ◽  
Ruchi Bhandari ◽  
Stephanie S Boyd ◽  
Neil Reece ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Substance Use ◽  
Infectious Diseases ◽  
Substance Use Disorder ◽  
Antimicrobial Therapy ◽  
Addiction Treatment ◽  
Healthcare Providers ◽  
Injection Drugs ◽  
Addiction Therapy

Abstract Background Injection drug use is associated with infectious diseases such as endocarditis and osteomyelitis requiring prolonged intravenous (IV) antimicrobial therapy. Few programs offer simultaneous inpatient infectious disease and addiction treatment. WVU Medicine implemented a multidisciplinary Infusion Service (IS) to provide IV antimicrobial therapy while treating substance use disorder. From 2017 through 2019, IS cared for over 840 patients. The aim of this study was to evaluate IS by assessing patients’ perspectives of overall experience, interactions with healthcare providers, and preparation for continued recovery from substance use. Methods Adults ≥ 18 and &lt; 90 years-old with substance use disorder on IS between November 2019 and May 2020 were eligible. Demographic, substance use, and infectious diseases data were obtained by chart review. Confidential surveys with questions about overall experience, interactions with healthcare providers, and preparation for continued recovery were administered during the first week after transfer to IS and again the week of discharge. Results Forty-two patients completed 39 initial and 12 follow up surveys. All used injection drugs, 85.7% (36/42) used opioids and 66.7% (28/42) used methamphetamine. Endocarditis was most common infection (61.9% (26/42)), with Staphylococcus aureus most often isolated (59.5% (25/42)). IS experience and care for infection were excellent or good in 97.4% (38/39) initial and 100% (12/12) follow up surveys. During IS, patients did not perceive being treated differently due to substance use in 94.9% (37/39) initial and 83.3% (10/12) follow up surveys. Before IS, patients perceived being treated differently in 84.6% (33/39) initial and 100% (12/12) follow up surveys. Patients felt IS would help with continued recovery in 84.6% (33/39) initial and 100% (12/12) follow up surveys. Conclusion According to patients’ perspectives, IS is effective in creating a positive overall healthcare experience, reducing stigma associated with substance use, and preparing patients for continued recovery after discharge. This study supports combining inpatient infectious disease and addiction therapy. Infectious diseases providers should be educated about this multidisciplinary approach. Disclosures All Authors: No reported disclosures

scholarly journals The use, appropriateness and outcomes of outpatient parenteral antimicrobial therapy

2016 ◽  
Vol 101 (10) ◽  
pp. 886-893 ◽  
Author(s):  
Kate A Hodgson ◽  
Julie Huynh ◽  
Laila F Ibrahim ◽  
Bronwyn Sacks ◽  
Daniel Golshevsky ◽  
...  
Keyword(s):  
Adverse Events ◽  
Antimicrobial Therapy ◽  
Readmission Rate ◽  
Bloodstream Infections ◽  
Antibiotic Use ◽  
Venous Access ◽  
Central Line ◽  
Unplanned Readmission ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Inappropriate Choice

ObjectiveOutpatient parenteral antimicrobial therapy (OPAT) is increasingly used to treat children at home, but studies in children are scarce. We aimed to describe the use, appropriateness and outcomes of OPAT in children.DesignThis was a 12-month prospective observational study.SettingThe hospital-in-the-home programme of The Royal Children's Hospital Melbourne.PatientsAll patients receiving OPAT.InterventionsData were collected including demographics, diagnosis, type of venous access and antibiotic choice.Main outcome measuresLength of stay, adverse events, readmission rate and appropriateness of antibiotic use.Results228 patients received OPAT in 251 episodes. The median age was 7.4 years (range 1 week to 21 years), with 22 patients (10%) under 1 year. The most frequent diagnoses were exacerbation of cystic fibrosis (17%), urinary tract infection (12%) and cellulitis (9%). Most patients were transferred from the ward, but 18% were transferred directly from the emergency department, the majority with skin and soft-tissue infection (66%). Venous access was most commonly peripherally inserted central catheter (29%) and peripheral cannula (29%). 309 parenteral antibiotics were prescribed, most frequently ceftriaxone (28%) and gentamicin (19%). The majority of antibiotics (72%) were prescribed appropriately. However, 6% were deemed an inappropriate choice for the indication and 26% had inappropriate dose or duration. The incidence of central line-associated bloodstream infections was 0.9%. The unplanned readmission rate was 4%, with low rates of OPAT-related adverse events. Three children (1%) had an inadequate clinical response.ConclusionsOPAT is a safe and effective way of providing antibiotics to children. Despite high rates of appropriate antibiotic use, improvements can still be made.

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