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 Experiences in outpatient parenteral antimicrobial therapy (OPAT): Barriers and challenges from the front lines

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Nicole Ng ◽  
Pamela Bailey ◽  
Rachel Pryor ◽  
Lillian Fung ◽  
Christine Veals ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Adverse Drug Events ◽  
Tertiary Care ◽  
Healthcare Spending ◽  
Healthcare Facility ◽  
Care Hospital ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Barriers And Challenges

Abstract Background: Outpatient parenteral antimicrobial therapy (OPAT) is now the standard of care for managing patients who no longer need inpatient care but require prolonged intravenous antimicrobial therapy. OPAT increases patient satisfaction, reduces the lengths of hospital stay, lowers emergency department readmission rates, and decreases total healthcare spending. Objective: To investigate Virginia Commonwealth University Health System’s experience with OPAT and to highlight the obstacles patients and clinicians face when navigating and utilizing this program. Design: We conducted this descriptive study at a large, academic, tertiary-care hospital in Central Virginia. Methods: We performed manual reviews of electronic medical records of 602 patient, and we evaluated the records of those receiving OPAT between 2017 and 2020. Reviews included antimicrobial agents, diagnoses requiring OPAT, adverse effects related to antimicrobials, adverse effects related to peripherally inserted central catheters (PICC), readmission rate, discharge destination, and death. We evaluated our program with descriptive statistics. Results: Among 602 patients who received OPAT, most were diagnosed with bacteremia or musculoskeletal infections. Patients were either discharged home or to another healthcare facility, with the former comprising most of the rehospitalizations. Ertapenem and vancomycin were associated with the most adverse drug events among our cohort. Elevated transaminase levels were noted in 23% of patients. The rate of PICC-line adverse events in this study population was 0.05%. Conclusions: Our findings highlight the barriers and challenges that patients and providers face when receiving OPAT, and they can inform efforts to improve patient clinical outcomes.

scholarly journals 623. Self-Administered Outpatient Parenteral Antimicrobial Therapy (S-OPAT) in Uninsured Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S371-S371
Author(s):  
Yasir Hamad ◽  
Jaspur Min ◽  
Yvonne Burnett
Keyword(s):  
Antimicrobial Therapy ◽  
Adverse Drug Events ◽  
Hospital Length ◽  
Clinic Visit ◽  
Hospital Length Of Stay ◽  
Uninsured Patients ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Joint Infections ◽  
Insured Patients ◽  
Hospital Days

Abstract Background Uninsured patients requiring long-term intravenous (IV) antimicrobials do not have access to outpatient parenteral antimicrobial therapy (OPAT) and often remain hospitalized for the duration of their treatment, transition to inferior oral antimicrobials, or leave against medical advice. A hospital-supported self-administered OPAT (S-OPAT) program was piloted in uninsured patients to decrease hospital length of stay and improve access to care. Methods Uninsured adult patients requiring IV antimicrobials were enrolled in an S-OPAT pilot study from July 2019 to April 2020. Patients with drug use history or documented non-adherence were excluded. S-OPAT patients attended weekly clinic visits for blood draws, dressing changes, and medication supply. The measured outcomes were hospital days saved, and potential income generated by earlier discharges. The latter was calculated by multiplying the number of hospital days saved by the daily charge for a hospital bed to insured patients. Results Seventeen patients were enrolled in S-OPAT, 14 (82%) were males, 8 (47%) were black, and the mean age was 39 years. The most common indication for OPAT was bone and joint infections in 12 (71%), and most commonly used antibiotic was ceftriaxone in 12 (71%) patients (Table). Early discontinuation occurred in 3 (17%) patients due to clinic visit non-adherence resulted in 2 (12%) and adverse drug events in 1 (6%). Only one (6%) patient had unplanned hospital readmission during OPAT. Transition to S-OPAT resulted in 533 hospital days avoided, and a net saving of approximately $900,000. Conclusion S-OPAT model is safe and can enhance care for uninsured patients while optimizing health-system resources. Table Disclosures All Authors: No reported disclosures

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

scholarly journals Outpatient parenteral antimicrobial therapy: updated recommendations from the UK

2019 ◽  
Vol 74 (11) ◽  
pp. 3125-3127 ◽  
Author(s):  
Ann L N Chapman ◽  
Sanjay Patel ◽  
Carolyne Horner ◽  
Mark Gilchrist ◽  
R Andrew Seaton
Keyword(s):  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Good Practice ◽  
Intravenous Therapy ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Stakeholder Consultation ◽  
Practice Recommendations ◽  
Recent Developments ◽  
Adults And Children ◽  
The Uk

Abstract Outpatient parenteral antimicrobial therapy (OPAT) offers safe, effective and patient-centred care for adults and children. The OPAT UK good practice recommendations for adults and children have recently been updated through a process of literature review, expert consensus and extensive stakeholder consultation. Here we discuss the key changes in the updated recommendations in the context of recent developments, including novel antimicrobial agents and delivery devices, the place of oral antimicrobials as an alternative to intravenous therapy, new OPAT service models and the broader antimicrobial stewardship agenda.

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 760Piperacillin/Tazobactam-Induced Adverse Drug Events in Pediatric Patients on Outpatient Parenteral Antimicrobial Therapy (OPAT)

2014 ◽  
Vol 1 (suppl_1) ◽  
pp. S214-S215
Author(s):  
Dawood Yusef ◽  
Blanca E Gonzalez ◽  
Charles B Foster ◽  
Johanna Goldfarb ◽  
Carla Saracusa ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Pediatric Patients ◽  
Adverse Drug Events ◽  
Outpatient Parenteral Antimicrobial Therapy

scholarly journals Experience with Liposomal Amphotericin B in Outpatient Parenteral Antimicrobial Therapy (OPAT)

2021 ◽  
Author(s):  
Yvonne J. Burnett ◽  
Andrej Spec ◽  
Mohamed M. Ahmed ◽  
William G. Powderly ◽  
Yasir Hamad
Keyword(s):  
Amphotericin B ◽  
Antimicrobial Therapy ◽  
Liposomal Amphotericin ◽  
Kidney Injury ◽  
Outpatient Setting ◽  
Primary Objective ◽  
Liposomal Amphotericin B ◽  
Close Monitoring ◽  
Outpatient Parenteral Antimicrobial Therapy

Background: Outpatient parenteral antimicrobial therapy (OPAT) is a safe, effective, and convenient treatment strategy for patients receiving intravenous antimicrobials in the outpatient setting; however, data is limited describing the use and safety of liposomal amphotericin B (L-AMB). Methods: Records of patients receiving L-AMB OPAT between 1/1/2015 and 7/31/2018 were retrospectively reviewed. The primary objective was to describe the OPAT patient population discharged on L-AMB and evaluate factors associated with readmission and adverse events (AE). Analysis was performed to evaluate for predictors of worse outcomes. Results: Forty-two patients (67% male, median age 50 years) were identified, most commonly treated for histoplasmosis. The most common doses of L-AMB were 3 mg/kg (n=16, 38%) or 5 mg/kg (n=14, 33%) based on actual body weight. Twenty-six (62%) patients completed their anticipated course of L-AMB. Twenty-two (52%) patients were readmitted within 30 days of discharge, median time to readmission was 11 days (Interquartile range [IQR] 5-18). While hypokalemia and acute kidney injury (AKI) were common, occurring in 26 (62%) and 20 (48%), respectively, only 5 (12%) were readmitted to the hospital due L-AMB-associated AE. Ninety percent of patients achieved at least partial renal recovery within 30 days after L-AMB discontinuation. Factors significantly associated with AKI include higher L-AMB dose, lower serum potassium levels after therapy initiation, and receipt of potassium supplementation at discharge. Conclusion: L-AMB is associated with significant AEs; however, these results suggest treatment is feasible in the outpatient setting with close monitoring, as the majority of AEs were managed effectively as an outpatient without long-term sequelae.

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