scholarly journals 613. Clinical Outcomes Following Dalbavancin Administration during Outpatient Parenteral Antimicrobial Therapy

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S410-S410
Author(s):  
Jessica Tuan ◽  
Jehanzeb Kayani ◽  
Ann Fisher ◽  
Brian Kotansky ◽  
Louise Dembry ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Clinical Cure ◽  
Veterans Affairs ◽  
Short Term ◽  
Gram Positive ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
All Cause Mortality ◽  
Antibiotic Duration ◽  
Staphylococcus Spp ◽  
Median Hospital

Abstract Background Dalbavancin, a lipoglycopeptide with prolonged half-life targeting Gram-positive organisms, is approved for treatment of acute bacterial skin and soft tissue infection. It reduces hospital duration in patients with barriers to short-term rehabilitation or outpatient parenteral antimicrobial therapy (OPAT). Increasing evidence supports the off-label use of dalbavancin to treat other types of infection. We conducted a quality improvement study to evaluate outcomes following dalbavancin administration. Methods We performed a cohort study of recipients of ≥1 dose of dalbavancin from 1/31/2016-1/31/2021 at the Veterans Affairs Connecticut Healthcare System. Demographic, comorbidity, microbiological, antibiotic duration prior to dalbavancin, indication for dalbavancin, and type of infection data were collected. Outcomes included 1) lab abnormalities: hepatotoxicity within 2 weeks of dalbavancin; 2) clinical cure: resolution of symptoms of infection within 90 days; 3) all-cause readmission within 90 days; and 4) all-cause mortality within 90 days. Results 42 patients met criteria. Median age was 69 years (range, 32-91), 100% were male, 55% (n=23) had diabetes, 31% (n=13) had liver disease, 36% (n=15) had other immunosuppressive conditions, and 12% (n=5) had substance use disorder (SUD). All received their first dose as inpatients. Median hospital duration was 8 days (range, 1-32). 4 (10%) required critical care. Median antibiotic duration prior to dalbavancin was 7 days (range, 1-42). Indications included ineligibility for OPAT (n=21, 50%), pharmacologic reasons (n=10, 24%), ineligibility for peripherally inserted central catheter (n=6, 14%), or SUD (n=5, 12%). Common microorganisms were Staphylococcus spp. (n=22, 52%), polymicrobial (n=13, 31%), and Corynebacterium spp. (n=10, 24%). 93% (n=39) had clinical cure of infection; readmissions and mortality were rare (Table 1). Conclusion Dalbavancin was associated with clinical cure for diverse infections with low rates of adverse events, readmission and mortality in patients ineligible for traditional OPAT. Although confirmatory data are needed from larger studies, dalbavancin appears to be a versatile therapeutic agent for Gram-positive infections. Disclosures All Authors: No reported disclosures

scholarly journals Outcomes of Outpatient Parenteral Antimicrobial Therapy With Ceftriaxone for Methicillin-Susceptible Staphylococcus aureus Bloodstream Infections—A Single-Center Observational Study

2020 ◽  
Vol 7 (9) ◽  
Author(s):  
Yasir Hamad ◽  
Lee Connor ◽  
Thomas C Bailey ◽  
Ige A George
Keyword(s):  
Staphylococcus Aureus ◽  
Antimicrobial Therapy ◽  
Adverse Outcome ◽  
Bloodstream Infections ◽  
Intensive Care Unit Care ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Mssa Infection ◽  
Single Center Observational Study

Abstract Background Staphylococcus aureus bloodstream infections (BSIs) are associated with significant morbidity and mortality. Ceftriaxone is convenient for outpatient parenteral antimicrobial therapy (OPAT), but data for this indication are limited. Methods Adult patients with methicillin-susceptible Staphylococcus aureus (MSSA) BSI discharged on OPAT with cefazolin, oxacillin, or ceftriaxone for at least 7 days were included. We compared outcomes of ceftriaxone vs either oxacillin or cefazolin. Ninety-day all-cause mortality, readmission due to MSSA infection, and microbiological failure were examined as a composite outcome and compared among groups. Rates of antibiotic switches due to intolerance were assessed. Results Of 243 patients included, 148 (61%) were discharged on ceftriaxone and 95 (39%) were discharged on either oxacillin or cefazolin. The ceftriaxone group had lower rates of intensive care unit care, endocarditis, and shorter duration of bacteremia, but higher rates of cancer diagnoses. There was no significant difference in the composite adverse outcome in the oxacillin or cefazolin group vs the ceftriaxone group (18 [19%] vs 31 [21%]; P = .70), comprising microbiological failure (6 [6.3%] vs 9 [6.1%]; P = .94), 90-day all-cause mortality (7 [7.4%] vs 15 [10.1%]; P = .46), and readmission due to MSSA infection (10 [10.5%] vs 13 [8.8%]; P = .65). Antibiotic intolerance necessitating a change was similar between the 2 groups (4 [4.2%] vs 6 [4.1%]; P = .95). Conclusions For patients with MSSA BSI discharged on OPAT, within the limitations of the small numbers and retrospective design we did not find a significant difference in outcomes for ceftriaxone therapy when compared with oxacillin or cefazolin therapy.

scholarly journals 1243. Comparative Analysis of Antimicrobial-related Adverse Events in the Outpatient Treatment of Staphylococcal Infections

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S378-S378
Author(s):  
Bradley Smith ◽  
Christina Rivera ◽  
Ross Dierkhising ◽  
Lynn Estes ◽  
John O’Horo ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Adverse Drug Events ◽  
Primary Objective ◽  
Gram Positive ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Staphylococcal Infections ◽  
Single Center Study ◽  
Therapy Modification

Abstract Background Limited data exist to evaluate safety-related outcomes in Outpatient Parenteral Antimicrobial Therapy (OPAT) patients treated with antimicrobial agents for Gram-positive infections. Methods This retrospective, single-center study enrolled Mayo Clinic OPAT patients between 2013 and 2017. The primary objective of the study compared rates of therapy modification due to drug-related toxicity for staphylococcal infections treated with ceftriaxone, cefazolin, nafcillin, oxacillin, vancomycin, daptomycin, ceftaroline, linezolid, or ertapenem. Secondary objectives included determination of the frequency and type of adverse drug events (ADEs) attributed to OPAT and rate of readmission due to ADEs attributed to OPAT. Results One hundred seventy-two patients were identified (cefazolin n = 54, ceftriaxone n = 49, vancomycin n = 30, daptomycin n = 16, nafcillin n = 9, ertapenem n = 6, ceftaroline n = 4, oxacillin n = 3, linezolid n = 1). The overall treatment completion rates were high (153/172, 89.0%). Patients completed an average of 35.3 days (7 to 95) of therapy with their original antibiotic. Fourteen patients required change to a different antibiotic due to antimicrobial toxicity (ceftriaxone=5; vancomycin=2; cefazolin = 2; daptomycin = 2; ceftaroline = 1; nafcillin = 1; oxacillin = 1) and five patients experienced treatment failure required an additional agent (ceftriaxone = 2; nafcillin = 2; linezolid = 1). Adverse drug events (ADEs) were the most common reason for antimicrobial adjustment (14/19, 73.7%). The most common ADEs were hypokalemia (28/172, 16.3%) and diarrhea (25/172, 14.5%). There were only two cases of Clostridium difficile. Thirty-day readmissions due to antimicrobial therapy were low with 11 patients. Conclusion OPAT with Gram-positive agents used for staphylococcal infections is effective, but antimicrobial modifications still occur. Clinicians should be aware of the risk of ADEs and readmissions in OPAT patients. A multidisciplinary approach may enhance management of ADEs and possibly preventing readmissions Disclosures All authors: No reported disclosures.

scholarly journals Outpatient Parenteral Antimicrobial Therapy (OPAT) Practices at a Veterans Affairs Hospital: Potential for Pharmacist Impact

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S331-S331
Author(s):  
Catherine Yang ◽  
Nancy N Nguyen ◽  
Aarthi Chary ◽  
Trisha S Nakasone
Keyword(s):  
Treatment Failure ◽  
Clinical Cure ◽  
Complete Blood Count ◽  
Veterans Affairs ◽  
Failure Group ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Optimal Monitoring ◽  
Basic Metabolic Panel ◽  
Common Infections

Abstract Background The Infectious Diseases Society of America (IDSA) OPAT Practice Guidelines and Handbook recommend multidisciplinary team involvement as a key element to the success of OPAT. Studies have demonstrated that OPAT pharmacist oversight can improve monitoring of intravenous (IV) antibiotics and achieve clinical cure in 77% of patients. Pharmacists at the Veterans Affairs Palo Alto Health Care System are currently not routinely involved with the management of OPAT patients. Methods A retrospective analysis was performed to determine the rate of adherence to IDSA recommendations on antibiotic laboratory and clinical monitoring in veterans discharged with OPAT between July 1, 2015 and June 30, 2016. Secondary outcomes assessed were rates of clinical cure, treatment failure, readmission, and OPAT complications. Data was analyzed using descriptive statistics. Results Of 83 patients evaluated, 91 IV antibiotics were administered and 70 patients completed OPAT. The most common infections were osteomyelitis (n = 33, 40%), bacteremia (n = 13, 13%), and skin and soft-tissue infection (n = 9, 11%). Cephalosporins (n = 41, 45%) were most commonly used, followed by vancomycin
(n = 18, 20%) and penicillins (n = 12, 13%). Appropriate monitoring of complete blood count, basic metabolic panel, and liver function occurred 45%, 45%, and 25% of the time, respectively, based on IDSA guidance. An increase in treatment failure was observed when less than 25% of weekly lab monitoring was conducted. Twenty-six patients (31%) met the IDSA recommendation for follow-up visits within 7–14 days of discharge and 51 patients (61%) received follow-up visits upon OPAT completion. Clinical cure was achieved in 52 patients (63%). There were more 90-day readmissions related to infection, adverse drug reactions, catheter-related complications, and C. difficile infections reported in the treatment failure group compared with the clinical cure group. Conclusion In most cases, IDSA recommendations on OPAT management were not appropriately followed and lack of monitoring was associated with treatment failure. Fewer patients achieved clinical cure compared with rates documented in the literature, strongly suggesting the need for an OPAT pharmacist to achieve optimal monitoring and follow-up. Disclosures All authors: No reported disclosures.

scholarly journals 755. Outpatient Parenteral Antimicrobial Therapy Program Evaluation within a Large Veterans Affairs Healthcare System

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S337-S337
Author(s):  
Michael Kent ◽  
Marcus Kouma ◽  
Jodlowski Tomasz ◽  
James B Cutrell ◽  
James B Cutrell
Keyword(s):  
Antimicrobial Therapy ◽  
Geographic Region ◽  
Veterans Affairs ◽  
Third Party ◽  
North Texas ◽  
Improvement Project ◽  
Telephone Consultation ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Prosthetic Joint Infections ◽  
Va Hospitals

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) allows safe delivery of IV antibiotics in ambulatory settings to facilitate hospital discharge. Within the Veterans Affairs (VA) system, OPAT programs face the unique challenges of large geographic coverage areas and referrals for veterans from non-VA hospitals. Methods Patients enrolled in the VA North Texas Health Care System OPAT program during fiscal years 2016 to 2018 had data collected on demographics, comorbidities, OPAT indications, antimicrobials used, pharmacist interventions, and complications during therapy. Data were collected from retrospective chart review as a quality improvement project. All enrolled OPAT patients required either an inpatient infectious disease (ID) consult or, for patients from non-VA facilities, required medical records review and telephone consultation with approval by a VA ID clinician. A third-party infusion company provided all medications and line care. Weekly laboratory monitoring and follow-up telephone visits were conducted by ID-trained pharmacists. Results During the evaluation period, 485 unique OPAT encounters (425 patients) were completed, with 164 patients (33%) directly admitted to OPAT upon referral from non-VA hospitals. Most common OPAT indications were osteomyelitis/diabetic foot infections (40.4%), bacteremia (17.3%), prosthetic joint infections/septic arthritis (12.4%), and urinary/intrabdominal infections (11.7%). Following standardization of pharmacist documentation, the volume and consistency of documented notes and interventions increased. Readmission rates while on therapy were similar, ranging from 13.4% to 13.7% each year. Patient demographics and OPAT outcomes demonstrated steady growth in the program (Table 1) with low rates of complications on therapy (Table 2). The program served patients in 35 counties and 158 zip codes across a broad geographic region in North Texas and southern Oklahoma (Figure 1). The most commonly used antibiotics are shown in Figure 2. Conclusion Our program has demonstrated the ability to safely and effectively provide OPAT across a large geographic region from a central location. ID-trained clinical pharmacists are critical to the care coordination and safety monitoring of OPAT in this unique setting. Disclosures All authors: No reported disclosures.

scholarly journals 1116. Comparison of Short-Course vs. Prolonged-Course Antimicrobial Therapy in the Management of Intra-Abdominal Infections

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S334-S334
Author(s):  
Mina Phlamon ◽  
Sarah Petite ◽  
Kelli Cole
Keyword(s):  
Logistic Regression ◽  
Antimicrobial Therapy ◽  
Clinical Cure ◽  
Antimicrobial Treatment ◽  
Multivariable Logistic Regression ◽  
Short Course ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Secondary Outcomes ◽  
Abdominal Infections

Abstract Background When managing complicated intra-abdominal infections (IAIs), the current Infectious Diseases Society of America (IDSA) guidelines recommend an antimicrobial treatment duration of 4–7 days. Although recent evidence supports this shorter course of therapy, antimicrobials are still often administered for 10–14 days due to concern for subsequent complications. The purpose of this study was to compare clinical outcomes of short-course (SC) vs. prolonged-course (PC) antimicrobial therapy in the management of IAI at our institution. Methods IRB-approved, single-center, retrospective cohort including all patients at the University of Toledo Medical Center who were admitted between January 1, 2012–June 30, 2017 with an IAI, received antimicrobials for ≥48 hours, and had at least one sign of IAI. Patients with concomitant infections at sites other than the abdomen, primary peritonitis or pancreatitis, immunocompromising conditions, or bacteremia were excluded. Primary outcome of clinical cure was compared between SC (≤7 days of antimicrobial treatment) and PC (>7 days) groups. Secondary outcomes included hospital length of stay (LOS), ICU LOS, 28-day all-cause mortality, and 30-day readmission. Multivariable logistic regression was performed to assess for factors associated with clinical cure. Results One hundred seventy-five patients were included, 73 SC and 102 PC. Baseline characteristics were similar between groups. Rate of clinical cure for SC vs. PC was 74.0% vs. 67.6% (P = 0.367). Secondary outcomes including hospital LOS (5.5 days vs. 5.8 days, P = 0.372), ICU LOS (3.0 days vs. 5.0 days, P = 0.117), 28-day all-cause mortality (4.1% vs. 2.0%, P = 0.651), and 30-day readmission (19.2% vs. 20.6%, P = 0.818) were also not significantly different. After multivariable logistic regression, the only variable independently associated with clinical cure was diverticulitis (adjusted odds ratio 0.337, 95% CI 0.133 – 0.853). Conclusion In patients with IAI, there was no significant difference observed in rates of clinical cure between SC and PC antimicrobial therapy. These results further support the IDSA recommendations for a shorter duration of therapy for patients with IAI. Disclosures All authors: No reported disclosures.

scholarly journals 1297Evaluation of Outpatient Parenteral Antimicrobial Therapy (OPAT) at a Veterans Affairs (VA) Hospital

2014 ◽  
Vol 1 (suppl_1) ◽  
pp. S51-S51
Author(s):  
Emily Sydnor ◽  
Brian Kendall ◽  
Patricia Orlando ◽  
Christian Perez ◽  
Matthew Samore ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Veterans Affairs ◽  
Outpatient Parenteral Antimicrobial Therapy

Evaluation of Outpatient Parenteral Antimicrobial Therapy at a Veterans Affairs Hospital

2015 ◽  
Vol 36 (9) ◽  
pp. 1103-1105 ◽  
Author(s):  
Emily Sydnor Spivak ◽  
Brian Kendall ◽  
Patricia Orlando ◽  
Christian Perez ◽  
Marina De Amorim ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Medical Center ◽  
Veterans Affairs ◽  
Infect Control Hosp ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Infectious Diseases Consultation

We reviewed outpatient parenteral antimicrobial therapy at a Veterans Affairs Medical Center to identify opportunities for antimicrobial stewardship intervention. A definite or possible modification would have been recommended in 60% of courses. Forty-one percent of outpatient parenteral antimicrobial therapy courses were potentially avoidable, including 22% involving infectious diseases consultation.Infect. Control Hosp. Epidemiol. 2015;36(9):1103–1105

Characteristics of the etiological structure and susceptibility to antibiotics, antiseptics of infectious pathogens of respiratory organs in children in critical states

2018 ◽  
Vol 22 (2) ◽  
pp. 311-317
Author(s):  
O.A. Nazarchuk ◽  
A.I. Starodub ◽  
O.V. Rymsha ◽  
V.A. Starodub ◽  
S.A. Kolodii
Keyword(s):  
Antimicrobial Activity ◽  
Antibacterial Agents ◽  
Inflammatory Diseases ◽  
Diffusion Method ◽  
Chlorhexidine Digluconate ◽  
Gram Positive ◽  
Critical States ◽  
Results Of Treatment ◽  
Moderate Resistance ◽  
Staphylococcus Spp

The study of the etiological structure, the properties of pathogens of the respiratory infectious diseases in children and their resistance to antibacterial agents is particularly relevant in modern conditions, expands the search for new approaches to combating pathogens, improves the results of treatment and reduces the mortality of this pathology. The aim — study of etiological structure, sensitivity to antibiotics and antiseptics of pathogens of infectious and inflammatory diseases of respiratory organs in children. In the study there were enrolled 247 patients who were treated in Vinnytsia Regional Children’s Clinical Hospital (VRCCH) in 2016. The sensitivity of microorganisms to 23 antibacterial agents was determined by the disc-diffusion method according to the generally accepted method. The analysis of the antimicrobial activity of antiseptic drugs (decamethoxine, miramistin, chlorhexidine digluconate) was performed by a double serial dilution technique with the determination of the minimum inhibitory bacteriostatic (MIC) and bactericidal (MBcC) concentrations, by the method of successive serial dilutions of the drug in a liquid nutrient medium. In patients who were in inpatient treatment at the VRCCH in 2016 because of pneumonia there were found opportunistic microorganisms which were of etiological significance in the development of the infection. Among them there were Streptococci (47,3 %), Staphylococci (15,3 %), Candida (13,3 %), Enterococci (10,9 %), including a high proportion of owned non-fermenting gram negative bacilli (9,8%) and species of Enterobacteria (2,0 %). Isolated strains of microorganisms had moderate resistance to most modern antibiotic drugs. The sensitivity of isolated strains of microorganisms to reserved antibiotics as carbapenems, often being used in the treatment of critical states of patients in the intensive care units, was found to above 18,2%. The sensitivity to this antibiotic in Enterococcus spp. (7,1 %), Staphylococcus spp. (5,9 %) was also low. Carbapenems, fluoroquinolones (the 1st and 2nd generations), antibiotics and aminoglycosides were found to be effective against gram positive microorganisms in more then 45% of cases. According to this they were considered to be as drugs of choice in the treatment of infectious and purulent-inflammatory pathology of respiratory organs, caused metitcilin- and vancomycin-resistant strains of microorganisms. Resistance to these drugs among investigated strains did not exceed 9,0 %. The high bactericidal properties of antiseptics as decamethoxine was determined against S.pyogenes, Staphylococcus spp. Its MBcC against these bacteria (1,65±0,20 mkg/ml and 4,32±0,50 mkg/ml, respectively) proved the advantage of decamethoxine’s effectiveness in comparison with chlorhexidine digluconate 3,14 times, 2,44 times miramistin. Clinical strains of C.albicans showed the highest susceptibility to decamethoxine, which fungicidal activity was determined in the presence (16,17±2,33 mkg/ml), in comparison with chlorxedine (MFtsK 27,59±3,59 mg/ml) and miramistin activity (27,59±3,595 mkg/ml). In children with inflammatory diseases of the respiratory organs gram-positive cocci are among the predominant pathogens (73,5 %) of cases, in the association allocated – 8,0 % of pathogens. Allocated strains of microorganisms were moderately resistant to all antibiotics studied. For antimicrobial activity antiseptic drugs, especially decamethoxine, have advantages over antibiotics confirming the possibility of their use in combination with systemic antibacterials.

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