Safety and efficacy of outpatient parenteral antibiotic therapy in an academic infectious disease clinic

Abstract Background Telavancin is an intravenous (IV) lipoglycopeptide with concentration-dependent bactericidal activity against a broad spectrum of gram-positive organisms and is approved for the treatment of skin and skin structure infections and nosocomial pneumonia; however, post-marketing data is limited. At a hospital-based Outpatient Parenteral Antibiotic Therapy (OPAT) unit, telavancin is used to treat patients due to its convenient daily dosing, its lack of need for therapeutic drug monitoring and its potent in-vitro gram-positive activity. We sought to evaluate the safety and efficacy of telavancin in the OPAT setting. Methods We performed a two-year, IRB-approved, retrospective evaluation of all adult patients admitted to the OPAT unit treated with telavancin. Primary outcome was clinical success defined as completion of telavancin and documented clinical resolution. Secondary outcomes included time to initial clinical improvement, 30-day infection related readmission, frequency and time to acute kidney injury (AKI) per RIFLE criteria and incidence of adverse drug reactions (ADRs). Results A total of 43 patients were evaluated. Median age was 51 years, 56% were male, and 84% were admitted from the hospital. Baseline demographics differed between clinical failure and success in BMI (38.1 vs. 31 P = 0.168), rates of diabetes mellitus (47% vs. 25% P = 0.148) and chronic vascular insufficiency (33% vs. 11% P = 0.104). Clinical success was observed in 28/43 patients (Figure 1). Successfully treated patients were more likely to be treated for abscesses (21% vs. 0% P = 0.076) and dosed using actual body weight (79% vs. 60% P = 0.196). AKI occurred in 4.7% of all patients, at a median of 7 days after starting (Figure 2). ADRs occurred in 9 patients, of whom 7 led to discontinuation (Figure 3). No difference in time to clinical resolution and 30-day infection-related readmission was observed. Conclusion Our study shows real-life experience with telavancin in an OPAT setting, demonstrating tolerability, efficacy, and potential factors which may predispose one to clinical failure (BMI, vascular insufficiency, and dosing weight). Further investigation is warranted to better individualize patient selection and optimize dosing and management of ADRs. Disclosures All authors: No reported disclosures.

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Value and Clinical Impact of an Infectious Disease-Supervised Outpatient Parenteral Antibiotic Therapy Program

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw193 ◽

2016 ◽

Vol 3 (4) ◽

Cited By ~ 10

Author(s):

Russell M. Petrak ◽

Nathan C. Skorodin ◽

Robert M. Fliegelman ◽

David W. Hines ◽

Vishnu V. Chundi ◽

...

Keyword(s):

Infectious Disease ◽

Antibiotic Therapy ◽

Primary Infection ◽

Clinical Relapse ◽

Therapeutic Success ◽

Parenteral Antibiotic ◽

Therapy Program ◽

Outpatient Parenteral Antibiotic Therapy ◽

Included Patient ◽

Ordinal Logistic Regression Analysis

Abstract Background. Outpatient parenteral antibiotic therapy (OPAT) is a safe and effective modality for treating serious infections. This study was undertaken to define the value of OPAT in a multicentered infectious disease (ID) private practice setting. Methods. Over a period of 32 months, 6120 patients were treated using 19 outpatient ID offices in 6 states. Analysis included patient demographics, indications of OPAT, diagnoses, therapeutic agent, duration of therapy, and site of therapy initiation. Outcomes were stratified by therapeutic success, clinical relapse, therapeutic complications, and hospitalizations after initiating therapy. Statistical analysis included an ordinal logistic regression analysis. Results. Forty-three percent of patients initiated therapy in an outpatient office, and 57% began therapy in a hospital. Most common diagnoses treated were bone and joint (32.2%), abscesses (18.8%), cellulitis (18.5%), and urinary tract infection (10.8%). Ninety-four percent of patients were successfully treated, and only 3% were hospitalized after beginning therapy. Most common cause of treatment failure was a relapse of primary infection (60%), progression of primary infection (21%), and therapeutic complication (19%). Conclusions. An ID-supervised OPAT program is safe, efficient, and clinically effective. By maximizing the delivery of outpatient care, OPAT provides a tangible value to hospitals, payers, and patients. This program is a distinctive competency available to ID physicians who offer this service to patients.

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