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.

Quality Improvement to Reduce Neonatal CLABSI: The Journey to Zero

2020 ◽  
Vol 37 (S 02) ◽  
pp. S14-S17
Author(s):  
Stephen A. Pearlman
Keyword(s):  
Quality Improvement ◽  
Central Venous Access ◽  
Bloodstream Infections ◽  
Venous Access ◽  
Central Line ◽  
Central Lines ◽  
The Past ◽  
Healthcare Improvement ◽  
Key Points ◽  
Innovative Techniques

Neonatal infections, including those associated with central lines, continue to be a major cause of morbidity and mortality despite many other improvements in neonatal outcomes. Over the past decades, significant advances have been made to reduce central line-associated bloodstream infections (CLABSIs) using quality improvement methodology. This article will review pertinent studies that used both the Institute for Healthcare Improvement Model for Improvement and other innovative techniques such as orchestrated testing and health care failure mode and effects analysis. These studies, by applying best practices, have demonstrated substantial and sustainable reductions in CLABSI. Some initiatives have been able to achieve rates of zero CLABSI for prolonged periods of time. While neonates often require prolonged central venous access and suffer from impaired immunity which increases the risk of CLABSI, this review demonstrates the journey to zero is feasible. Key Points

scholarly journals Chlorhexidine Bathing in a Tertiary Care Neonatal Intensive Care Unit: Impact on Central Line–Associated Bloodstream Infections

2014 ◽  
Vol 35 (2) ◽  
pp. 158-163 ◽  
Author(s):  
Caroline Quach ◽  
Aaron M. Milstone ◽  
Chantal Perpête ◽  
Mario Bonenfant ◽  
Dorothy L. Moore ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Adverse Events ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
The Impact

Background.Despite implementation of recommended best practices, our central line-associated bloodstream infection (CLABSI) rates remained high. Our objective was to describe the impact of chlorhexidine gluconate (CHG) bathing on CLABSI rates in neonates.Methods.Infants with a central venous catheter (CVC) admitted to the neonatal intensive care unit from April 2009 to March 2013 were included. Neonates with a birth weight of 1,000 g or less, aged less than 28 days, and those with a birth weight greater than 1,000 g were bathed with mild soap until March 31, 2012 (baseline), and with a 2% CHG-impregnated cloth starting on April 1, 2012 (intervention). Infants with a birth weight of 1,000 g or less, aged 28 days or more, were bathed with mild soap during the entire period. Neonatal intensive care unit nurses reported adverse events. Adjusted incidence rate ratios (aIRRs), using Poisson regression, were calculated to compare CLABSIs/1,000 CVC-days during the baseline and intervention periods.Results.Overall, 790 neonates with CVCs were included in the study. CLABSI rates decreased during the intervention period for CHG-bathed neonates (6.00 vs 1.92/1,000 CVC-days; aIRR, 0.33 [95% confidence interval (CI), 0.15-0.73]) but remained unchanged for neonates with a birth rate of 1,000 g or less and aged less than 28 days who were not eligible for CHG bathing (8.57 vs 8.62/1,000 CVC-days; aIRR, 0.86 [95% CI, 0.17-4.44]). Overall, 195 infants with a birth weight greater than 1,000 g and 24 infants with a birth weight of 1,000 g or less, aged 28 days or more, were bathed with CHG. There was no reported adverse event.Conclusions.We observed a decrease in CLABSI rates in CHG-bathed neonates in the absence of observed adverse events. CHG bathing should be considered if CLABSI rates remain high, despite the implementation of other recommended measures.

scholarly journals 776. Reducing Central Line Associated Bloodstream Infections (CLABSI) in a High-Risk Cohort of Patients by Standardizing Skin Preparation Prior to Pulmonary Artery Catheter Insertion

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S485-S485
Author(s):  
Mylinh Yun ◽  
Jay Varkey ◽  
Daniel Linehan ◽  
Elizabeth Noriega
Keyword(s):  
Pulmonary Artery ◽  
Central Venous Access ◽  
Bloodstream Infections ◽  
Venous Access ◽  
Central Line ◽  
Early Summer ◽  
Coverage Area ◽  
Skin Preparation ◽  
Correct Application ◽  
Instructions For Use

Abstract Background Central line associated bloodstream infections (CLABSI) are a recognized complication of all central venous access devices including pulmonary artery catheters (PAC). At our institution, PACs are utilized frequently, often for prolonged durations, for patients with advanced heart failure in the cardiac care unit (CCU) who are awaiting heart transplant. In early summer 2018, our hospital infection prevention (IP) department detected an uptick in CLABSI attributable to the CCU. After 9 months of zero CLABSI, two CLABSIs attributable to the CCU were identified during a 3 month period from November 2017-January 2018. Four additional CLABSIs were identified between May-July 2018 prompting an investigation by IP. Review of the 9 CLABSIs attributed to the CCU from May 2018 – June 2019 led IP to prioritize improving PAC insertion practices in our cardiac catheterization lab as a mean to reducing CLABSI (see table 1). Methods IP performed 5 observations of PAC insertion in the cath lab. During the observations of skin preparation, the prep time was performed correctly 40% of the time, correct application 60% of the time and dry time 60% of the time (see table 2, Figure1). Interventions included scheduling a training day for all cath lab staff with the skin prep vendor, performing competency check-offs, and identifying super-users to train future staff. Furthermore, skin antiseptic utilization according the manufacturer's instructions for use was implemented, the coverage area for the applicator was reviewed and a chart for reference was provided.The staff was provided with posters on correct skin prep technique as a visual cue in the procedure room. Results Since the project was implemented in September 2019, there has been 1 CLABSI identified that was possibly related to a PAC inserted in the cath lab. During this time 3 CLABSIs were identified in the CCU but were felt to be unrelated to cath lab insertion. Conclusion Since the project was implemented in September 2019, there has been 1 CLABSI identified that was possibly related to a PAC inserted in the cath lab. During this time 3 CLABSIs were identified in the CCU but were felt to be unrelated to cath lab insertion. 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 Adverse Events and Healthcare Utilization Associated With Outpatient Parenteral Antimicrobial Therapy Among Older Versus Younger Adults

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Kaylen Brzozowski ◽  
Rupak Datta ◽  
Joseph Canterino ◽  
Maricar Malinis ◽  
Manisha Juthani-Mehta
Keyword(s):  
Adverse Events ◽  
Confidence Interval ◽  
Healthcare Utilization ◽  
Antimicrobial Therapy ◽  
Odds Ratio ◽  
Rate Ratio ◽  
Adjusted Odds Ratio ◽  
Incidence Rate Ratio ◽  
Younger Adults ◽  
Outpatient Parenteral Antimicrobial Therapy

Abstract Among older (n = 204) versus younger (n = 253) adults, there was no difference in adverse events (adjusted odds ratio [aOR] = 0.98; 95% confidence interval [CI] = 0.6–1.6) or healthcare utilization (incidence rate ratio = 1.09; 95% CI = 0.9–1.3) within 30 days after discontinuing outpatient parenteral antimicrobial therapy. Vancomycin (aOR = 1.92) and oxacillin (aOR = 3.12) were independently associated with adverse events.

scholarly journals A Novel Nonantibiotic Nitroglycerin-Based Catheter Lock Solution for Prevention of Intraluminal Central Venous Catheter Infections in Cancer Patients

2017 ◽  
Vol 61 (7) ◽  
Author(s):  
Anne-Marie Chaftari ◽  
Ray Hachem ◽  
Ariel Szvalb ◽  
Mahnaz Taremi ◽  
Bruno Granwehr ◽  
...  
Keyword(s):  
Adverse Events ◽  
Cancer Patients ◽  
Randomized Clinical Trials ◽  
Residual Effect ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Current Standard ◽  
Lock Solution ◽  
Catheter Lock

ABSTRACT For long-term central lines (CL), the lumen is the major source of central line-associated bloodstream infections (CLABSI). The current standard of care for maintaining catheter patency includes flushing the CL with saline or heparin. Neither agent has any antimicrobial activity. Furthermore, heparin may enhance staphylococcal biofilm formation. We evaluated the safety and efficacy of a novel nonantibiotic catheter lock solution for the prevention of CLABSI. Between November 2015 and February 2016, we enrolled 60 patients with hematologic malignancies who had peripherally inserted central catheters (PICC) to receive the study lock solution. The study lock consisted of 15 or 30 μg/ml of nitroglycerin in combination with 4% sodium citrate and 22% ethanol. Each lumen was locked for at least 2 h once daily prior to being flushed. After enrollment of 10 patients at the lower nitroglycerin dose without evidence of toxicity, the dose was escalated to the higher dose (30 μg/ml). There were no serious related adverse events or episodes of hypotension with lock administration. Two patients experienced mild transient adverse events (one headache and one rash) possibly related to the lock and that resolved without residual effect. The CLABSI rate was 0 on lock days versus 1.6/1,000 catheter days (CD) off lock prophylaxis, compared with a rate of 1.9/1,000 CD at the institution in the same patient population. In conclusion, the nitroglycerin-based lock prophylaxis is safe and well tolerated. It may prevent CLABSI when given daily to cancer patients. Large, prospective, randomized clinical trials are needed to validate these findings. (This study has been registered at ClinicalTrials.gov under identifier NCT02577718.)

Central line bundle for prevention of central line–associated bloodstream infection for totally implantable venous access devices (ports) in pediatric cancer patients

2018 ◽  
Vol 19 (4) ◽  
pp. 358-365 ◽  
Author(s):  
İlker Devrim ◽  
Yeliz Oruç ◽  
Bengü Demirağ ◽  
Ahu Kara ◽  
Mine Düzgöl ◽  
...  
Keyword(s):  
Line Bundle ◽  
Bloodstream Infection ◽  
Removal Rate ◽  
Bloodstream Infections ◽  
Venous Access ◽  
Central Line ◽  
Pediatric Cancer Patients ◽  
Single Use ◽  
Venous Access Devices ◽  
Central Line Bundle

Objective: The clinical impact of central line bundle programs for central line–associated bloodstream infections has been well demonstrated in intensive care units. However, the experience of central line bundle programs in totally implantable venous access devices (ports) in pediatric-hematology patients was limited. Methods: A retrospective study was designed to compare and evaluate the clinical impact of implementing a central line bundle for a 2-year 5-month period, including 10 months of prebundle period, 11 months of central line bundle (that includes needleless split-septum devices), and finally 8 months of central line bundle period in which single-use prefilled flushing devices were added to the previous central line bundle. Results: During the prebundle period, the rate of 14.5 central line–associated bloodstream infections per 1000 CL-days had decreased to 5.49 CLABSIs per 1000 CL-days in the first bundle period. The incidence rate ratio with these two groups was 0.379, indicating a relative risk reduction of 62% ( p = 0.005). By the addition of single-use prefilled flushing devices to the first bundle program, the central line–associated bloodstream infection rate decreased to 2.63 per 1000 CL-days. Port removal rate due to central line–associated bloodstream infections was 0.46 per 1000 catheter days in the bundle period, which was significantly lower than in the prebundle period in which port removal rate was 4.5 per 1000 catheter days ( p < 0.001). Conclusion: Central line bundle programs were found to be effective in decreasing central line–associated bloodstream infection rates, improving patients’ quality of life by preventing ports removal due in pediatric cancer patients.

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

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