Risk factors for amendment in type, duration and setting of prescribed outpatient parenteral antimicrobial therapy (OPAT) for adult patients with cellulitis: a retrospective cohort study and CART analysis

Purpose of the studyTo measure the percentage rate and risk factors for amendment in the type, duration and setting of outpatient parenteral antimicrobial therapy (OPAT) for the treatment of cellulitis.Study designA retrospective cohort study of adult patients receiving OPAT for cellulitis was performed. Treatment amendment (TA) was defined as hospital admission or change in antibiotic therapy in order to achieve clinical response. Multivariable logistic regression (MVLR) and classification and regression tree (CART) analysis were performed.ResultsThere were 307 patients enrolled. TA occurred in 36 patients (11.7%). Significant risk factors for TA on MVLR were increased age, increased Numerical Pain Scale Score (NPSS) and immunocompromise. The median OPAT duration was 7 days. Increased age, heart rate and C reactive protein were associated with treatment prolongation. CART analysis selected age <64.5 years, female gender and NPSS <2.5 in the final model, generating a low-sensitivity (27.8%), high-specificity (97.1%) decision tree.ConclusionsIncreased age, NPSS and immunocompromise were associated with OPAT amendment. These identified risk factors can be used to support an evidence-based approach to patient selection for OPAT in cellulitis. The CART algorithm has good specificity but lacks sensitivity and is shown to be inferior in this study to logistic regression modelling.

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Risk Factors For Readmission Among Patients Receiving Outpatient Parenteral Antimicrobial Therapy; A Retrospective Cohort Study

10.21203/rs.3.rs-1104099/v1 ◽

2021 ◽

Author(s):

Sabrine Douiyeb ◽

Jara R. de la Court ◽

Bram Tuinte ◽

Ferdi Sombogaard ◽

Rogier P. Schade ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Therapeutic Drug Monitoring ◽

Antimicrobial Therapy ◽

Drug Monitoring ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Prosthetic Material ◽

Therapeutic Drug ◽

Outpatient Parenteral Antimicrobial Therapy

Abstract Background: In the Netherlands, home treatment with intravenous antimicrobial therapy is a relatively new concept. Although several studies have shown that outpatient parenteral antimicrobial therapy (OPAT) can be administered safely, people receiving antimicrobials at home remain at risk for adverse events, including readmission.Objectives: The aim of our retrospective study is to identify risk factors for readmission in patients discharged with OPAT.Method: Retrospective cohort study during a period of January 2016 - December 2018. Patients, age > 18 years, discharged with OPAT were included. Variables collected consisted of baseline demographics, complications, readmission within 30 days and treatment failure. Multivariate logistic regression analysis was performed to identify risk factors for readmission.Results: A total of 247 patients were included; the most common reason for OPAT was bone and joint infections (17%). Penicillin (37%), cephalosporin (26%) and vancomycin/aminoglycoside (15%) were the most commonly prescribed antimicrobials. Among the patients receiving medication subject to therapeutic drug monitoring (i.e. aminoglycosides or vancomycin), 51% (19/37) received weekly therapeutic drug monitoring. Receiving aminoglycosides or vancomycin (adjusted OR: 2.05; 95% CI, 1.30-3.25, p<0.05) and infection of prosthetic material (adjusted OR: 2.92, 95% CI, 1.11-7.65, p<0.05) were independent risk factors for readmission. Conclusion: Although patients receiving medication subject to therapeutic drug monitoring are at higher risk of readmission, only half of the patients discharged with aminoglycosides or vancomycin were monitored according to IDSA guidelines. A specialized team in charge of monitoring OPAT-patients is likely to increase the rate of monitoring to prevent readmissions and complications.

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Risk factors for readmission in patients discharged with outpatient parenteral antimicrobial therapy: a retrospective cohort study

BMC Pharmacology and Toxicology ◽

10.1186/s40360-018-0240-3 ◽

2018 ◽

Vol 19 (1) ◽

Cited By ~ 8

Author(s):

Victoria Huang ◽

Jorg J. Ruhe ◽

Polina Lerner ◽

Marianna Fedorenko

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Antimicrobial Therapy ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Outpatient Parenteral Antimicrobial Therapy

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Pre-Existing Lymphopenia Increases the Risk of Hospitalization and Death after SARS-CoV-2 Infection

Infectious Disease Reports ◽

10.3390/idr14010003 ◽

2022 ◽

Vol 14 (1) ◽

pp. 20-25

Author(s):

Riccardo Garbo ◽

Francesca Valent ◽

Gian Luigi Gigli ◽

Mariarosaria Valente

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Cohort Study ◽

General Population ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Logistic Regression Model ◽

Protective Factor ◽

Absolute Lymphocyte Count ◽

Limited Information

There is limited information regarding the severity of COVID-19 in immunocompromized patients. We conducted a retrospective cohort study considering the period from 1 March 2020 to 31 December 2020 to determine whether previously existing lymphopenia increases the risk of hospitalization and death after SARS-CoV-2 infection in the general population. The laboratory and hospital discharge databases of the Azienda Sanitaria Universitaria Friuli Centrale were used, and 5415 subjects infected with SARS-CoV-2 and with at least one recent absolute lymphocyte count determination before SARS-CoV-2 positivity were included. In total, 817 (15.1%) patients had severe COVID-19. Patients developing severe COVID-19 were more frequently males (44.9% of the severe COVID-19 group vs. 41.5% in the non-severe COVID-19 group; p < 0.0001) and were older (73.2 ± 13.8 vs. 58.4 ± 20.3 years; p < 0.0001). Furthermore, 29.9% of the lymphopenic patients developed severe COVID-19 vs. 14.5% of the non-lymphopenic patients (p < 0.0001). In a logistic regression model, female sex remained a protective factor (OR = 0.514, 95%CI 0.438–0.602, p < 0.0001), while age and lymphopenia remained risk factors for severe COVID-19 (OR = 1.047, 95%CI 1.042–1.053, p < 0.0001 for each additional year of age; OR = 1.715, 95%CI 1.239–2.347, p = 0.0011 for lymphopenia). This provides further information to stratify the risk of COVID-19 severity, which may be an important element in the management of immunosuppressive therapies.

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Vascular access complications during outpatient parenteral antimicrobial therapy at home: a retrospective cohort study

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkv344 ◽

2015 ◽

Vol 71 (2) ◽

pp. 506-512 ◽

Cited By ~ 20

Author(s):

Nabin K. Shrestha ◽

Jugnu Shrestha ◽

Angela Everett ◽

Donald Carroll ◽

Steven M. Gordon ◽

...

Keyword(s):

Cohort Study ◽

Vascular Access ◽

Antimicrobial Therapy ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Outpatient Parenteral Antimicrobial Therapy ◽

Access Complications ◽

At Home

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Cryptococcal meningitis in a tertiary hospital in Pretoria, mortality and risk factors – A retrospective cohort study

International Journal of STD & AIDS ◽

10.1177/0956462416653559 ◽

2016 ◽

Vol 28 (5) ◽

pp. 480-485 ◽

Cited By ~ 5

Author(s):

J Hiesgen ◽

C Schutte ◽

S Olorunju ◽

J Retief

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Cohort Study ◽

Antiretroviral Therapy ◽

Mortality Risk ◽

Retrospective Cohort Study ◽

Cryptococcal Meningitis ◽

Retrospective Cohort ◽

Nausea And Vomiting ◽

People Living With Hiv

Aim This retrospective cohort study analyzes the impact of possible risk factors on the survival chance of patients with cryptococcal meningitis. These factors include the patient’s socio-economic background, age, gender, presenting symptoms, comorbidities, laboratory findings and, in particular, non-adherence versus adherence to therapy. Methods Data were collected from all adult patients admitted to Kalafong Hospital with laboratory confirmed cryptococcal meningitis over a period of 24 months. We analyzed the data by the presentation of descriptive summary statistics, logistic regression was used to assess factors which showed association between outcome of measure and factor. Furthermore, multivariable logistic regression analysis using all the factors that showed significant association in the cross tabulation was applied to determine which factors had an impact on the patients’ mortality risk. Results A total of 87 patients were identified. All except one were HIV-positive, of which 55.2% were antiretroviral therapy naïve. A history of previous tuberculosis was given by 25 patients (28.7%) and 49 (56.3%) were on tuberculosis treatment at admission or started during their hospital stay. In-hospital mortality was 31%. Statistical analysis showed that antiretroviral therapy naïve patients had 9.9 (CI 95% 1.2–81.2, p < 0.0032) times greater odds of dying compared to those on antiretroviral therapy, with 17 from 48 patients (35.4%) dying compared with 1 out of 21 patients (4.8%) on treatment. Defaulters had 14.7 (CI 95% 1.6–131.6, p < 0.016) times greater odds of dying, with 9 from 18 patients dying (50%), compared to the non-defaulters. In addition, patients who presented with nausea and vomiting had a 6.3 (95% CI 1.7–23.1, p < 0.005) times greater odds of dying (18/47, 38.3%); this remained significant when adjusted for antiretroviral therapy naïve patients and defaulters. Conclusion Cryptococcal meningitis is still a common opportunistic infection in people living with HIV/AIDS resulting in hospitalization and a high mortality. Defaulting antiretroviral therapy and presentation with nausea and vomiting were associated with a significantly increased mortality risk.

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