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The Outpatient Parenteral Antimicrobial Therapy (OPAT) Experience in a Referral Hospital in South Carolina

Received: 20 September 2020    Accepted: 29 September 2020    Published: 13 October 2020
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Abstract

Several studies have established outpatient parenteral antibiotic therapy (OPAT) as an alternative to prolonged inpatient stays to reduce healthcare expenditure, decrease hospital admission times, and increase patient satisfaction. However, studies have also shown significant adverse events occurring while receiving treatment outpatient. We collected retrospective data through electronic medical record review on all patients discharged on IV antibiotics whose OPAT was managed by the infectious disease specialists at Greenville Health System between 1/1/17 and 6/30/17. There were a total of 336 individual patients discharged on OPAT during the 6 month period. Bacteremia (25.4%), osteomyelitis (14.9%), and diabetic foot infections (12.8%) were the most common indications for OPAT with methicillin-sensitive staphylococcus aureus (MSSA) being the most common organism targeted (22.5%). 11% of patients had a medication change during their treatment course. The most common reasons were nausea/malaise (26%) and acute kidney injury (26%). Our hospital re-admission rate was 8.7%. Statistical analysis of the data indicated that home infusion was significantly more likely to result in re-admission compared to the infusion center (p=0.02). Also receiving antibiotics for osteomyelitis was more likely to result in re-admission compared to other diagnoses (p=0.048). Our data indicates that self-administration of antibiotics at home results in higher re-admission rates compared to administration at infusion centers. Factors that may contribute to this difference such as compliance, co-morbidities, or frequency of nurse assessments warrant further exploration to optimize the safety of OPAT, especially in rural South Carolina.

Published in International Journal of Infectious Diseases and Therapy (Volume 5, Issue 4)
DOI 10.11648/j.ijidt.20200504.12
Page(s) 112-117
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Outpatient Parenteral Antimicrobial Therapy (OPAT), Infusion Center, Rural Home Care, Readmission

References
[1] Rucker RW, Harrison GM. Outpatient intravenous medications in the management of cystic fibrosis. Pediatrics 1974; 54: 358–60.
[2] Chapman ALN, Dixon S, Andrews D, Lillie PJ, Bazaz R, Patchett JD. Clinical Efficacy and Cost-Effectiveness of Outpatient Parenteral Antibiotic Therapy: a UK Perspective. Journal of Antimicrobial Chemotherapy. 2009; Vol. 64.
[3] Tice AD. The Use of Outpatient Parenteral Antimicrobial Therapy in the Management of Osteomyelitis: Data from the Outpatient Parenteral Antimicrobial Therapy Outcomes Registries. Chemotherapy. 2001; Vol. 47.
[4] Tice AD, Hoaglund PA, Shoultz DA. Outcomes of Osteomyelitis Among Patients Treated with OPAT. The American Journal of Medicine. 2003; Vol. 114.
[5] Seaton RA, Sharp E, Bezlyak V, Weir CJ. Factors Associated with Outcome and Duration of Therapy in Outpatient Parenteral Antibiotic Therapy (OPAT) Patients with Skin and Soft Tissue Infections. International Journal of Antimicrobial Agents. 2011; Vol. 38.
[6] Partridge DG, O’Brien E, Chapman AL. Outpatient Parenteral Antibiotic Therapy for Infective Endocarditis: A Review of 4 Years’ Experience at a UK Centre. Postgraduate Medical Journal. 2012; Vol. 88.
[7] Mujal A, Sola J, Hernandez M, Villarino M, Baylina M, Tajan J, Oristrell J. Safety and Effectiveness of Outpatient Parenteral Antimicrobial Therapy in Older People. Journal of Antimicrobial Chemotherapy. 2016; Vol. 71.
[8] Paladino JA, Poretz D. Outpatient Parenteral Antimicrobial Therapy Today. Clinical Infectious Diseases. 2010; Vol. 51 (Supplemental 2): S198-208.
[9] Matthews PC, Conlon CP, Berendt AR, Kayley J, Jefferies L, Atkins BL, Byren I. Outpatient Parenteral Antimicrobial Therapy: Is it Safe for Patients to Self-Administer at Home? A Retrospective Analysis of a Large Cohort over 13 Years. Journal of Antimicrobial Chemotherapy. 2007; Vol. 60.
[10] Chary A, Tice AD, Martinelli LP, Liedtke LA, Plantenga MS, Strausbaugh LJ. Experience of Infectious Disease Consultants with Outpatient Parenteral Antimicrobial Therapy: Results of an Emerging Infections Network Survey. Clinical Infectious Diseases. 2006; Vol. 43.
[11] Berman SJ, Johnson EW. Out-Patient Parenteral Antibiotic Therapy: Clinical Outcomes and Adverse Effects. Hawaii Medical Journal. 2001; Vol. 60.
[12] Sriskandarajah S, Hobbs J, Roughead E, Ryan M, Reynolds K. Safety and Effectiveness of ‘Hospital in the Home’ and ‘Outpatient Parenteral Antimicrobial Therapy’ in Different Age Groups: A Systematic Review of Observational Studies.” The International Journal of Clinical Practice. 2018.
[13] Hoffman-Terry ML, Fraimow HS, Fox TR, Swift BG, Wolf JE. Adverse Effects of Outpatient Parenteral Antibiotic Therapy. American Journal of Medicine. 1999; Vol. 106.
[14] Mackenzie M, Rae N, Nathwani D. Outcomes from Global Adult Outpatient Parenteral Antimicrobial Therapy Programmes: A Review of the Last Decade. International Journal of Antimicrobial Agents. 2014; Vol. 43.
[15] Mackintosh CL, White HA, Seaton RA. Outpatient Parenteral Antibiotic Therapy for Bone and Joint Infections: Experience from a UK Teaching Hospital. Journal of Antimicrobial Chemotherapy. 2011; Vol. 66.
[16] Means L, Bleasdale S, Sikka M, Gross AE. Predictors of Hospital Readmission in Patients Receiving OPAT. Pharmacotherapy. 2016; Vol. 36.
[17] Petrak RM, Skorodin NC, Fliegelman RM, Hines DW, Chundi VV, Harting BP. Value and Clinical Impact of an Infectious Disease Supervised Outpatient Parenteral Antibiotic Program. Open Forum Infectious Diseases. 2016.
[18] Allison GM, Muldoon EG, Kent DM, Paulus JK, Ruthazer R, Ren A, Syndman DR. Prediction Model for 30-Day Hospital Readmissions Among Patients Discharged Receiving Outpatient Parenteral Therapy. Clinical Infectious Diseases. 2014; Vol. 58.
[19] Huck D, Ginsberg, JP, Gordon, SM, Nowacki AS, Rehm SJ, Shrestha NK. Association of Laboratory Test Result Availability and Rehospitalizations in an Outpatient Parenteral Antimicrobial Therapy Programme. Journal of Antimicrobial Chemotherapy. 2014; Vol. 69.
[20] Keller SC, Williams D, Gavgani M, Hirsch D, Adamovich J, Hohl D, Gurses AP, Cosgrove SE. Rates of and Risk Factors for Adverse Drug Events in Outpatient Parenteral Antimicrobial Therapy. Clinical Infectious Diseases. 2017; Vol. 20.
[21] Kieran J, O’Reilly A, Parker J, Clarke S, Bergin C. Self-Administered Outpatient Parenteral Antimicrobial Therapy: A Report of Three Years Experience in the Irish Healthcare Setting. European Journal of Clinical Microbiology and Infectious Diseases. 2009; Vol. 28.
[22] Yan M, Elligsen M, Simor AE, Daneman N. Patient Characteristics and Outcomes of Outpatient Parenteral Antimicrobial Therapy: A Retrospective Study. Canadian Journal of Infectious Diseases and Medical Microbiology. 2016.
[23] Tice AD. Experience with a Physician-Directed, Clinic-Based Program for Outpatient Parenteral Antibiotic Therapy in the USA. European Journal of Clinical Microbiology and Infectious Diseases. 1995. Vol. 14; 655-661.
[24] Tice AD, Rehm SJ, Dalovisio JR, Bradley JS, Martinelli LP, Graham DR, Gainer RB, Kunkel MK, Yancey RW, Williams DN. Practice Guidelines for Outpatient Parenteral Antimicrobial Therapy. IDSA Guidelines. Clinical Infectious Diseases. 2004; Vol 38, 358-60.
[25] Tonna A, Anthony G, Tonna I, et al. Home self-administration of intravenous antibiotics as part of an outpatient parenteral antibiotic therapy service: a qualitative study of the perspectives of patients who do not self-administer. BMJ Open. 2019; 9 (1): e027475. Published 2019 Jan 25. doi: 10.1136/bmjopen-2018-027475.
[26] Bhavan KP, Brown LS, Haley RW (2015) Self-Administered Outpatient Antimicrobial Infusion by Uninsured Patients Discharged from a Safety-Net Hospital: A Propensity-Score-Balanced Retrospective Cohort Study. PLoS Med 12 (12): e1001922. https://doi.org/10.1371/journal.pmed.1001922.
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  • APA Style

    Julie Coursen, Prerana Roth, Christopher Schrank, John Schrank. (2020). The Outpatient Parenteral Antimicrobial Therapy (OPAT) Experience in a Referral Hospital in South Carolina. International Journal of Infectious Diseases and Therapy, 5(4), 112-117. https://doi.org/10.11648/j.ijidt.20200504.12

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    ACS Style

    Julie Coursen; Prerana Roth; Christopher Schrank; John Schrank. The Outpatient Parenteral Antimicrobial Therapy (OPAT) Experience in a Referral Hospital in South Carolina. Int. J. Infect. Dis. Ther. 2020, 5(4), 112-117. doi: 10.11648/j.ijidt.20200504.12

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    AMA Style

    Julie Coursen, Prerana Roth, Christopher Schrank, John Schrank. The Outpatient Parenteral Antimicrobial Therapy (OPAT) Experience in a Referral Hospital in South Carolina. Int J Infect Dis Ther. 2020;5(4):112-117. doi: 10.11648/j.ijidt.20200504.12

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  • @article{10.11648/j.ijidt.20200504.12,
      author = {Julie Coursen and Prerana Roth and Christopher Schrank and John Schrank},
      title = {The Outpatient Parenteral Antimicrobial Therapy (OPAT) Experience in a Referral Hospital in South Carolina},
      journal = {International Journal of Infectious Diseases and Therapy},
      volume = {5},
      number = {4},
      pages = {112-117},
      doi = {10.11648/j.ijidt.20200504.12},
      url = {https://doi.org/10.11648/j.ijidt.20200504.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijidt.20200504.12},
      abstract = {Several studies have established outpatient parenteral antibiotic therapy (OPAT) as an alternative to prolonged inpatient stays to reduce healthcare expenditure, decrease hospital admission times, and increase patient satisfaction. However, studies have also shown significant adverse events occurring while receiving treatment outpatient. We collected retrospective data through electronic medical record review on all patients discharged on IV antibiotics whose OPAT was managed by the infectious disease specialists at Greenville Health System between 1/1/17 and 6/30/17. There were a total of 336 individual patients discharged on OPAT during the 6 month period. Bacteremia (25.4%), osteomyelitis (14.9%), and diabetic foot infections (12.8%) were the most common indications for OPAT with methicillin-sensitive staphylococcus aureus (MSSA) being the most common organism targeted (22.5%). 11% of patients had a medication change during their treatment course. The most common reasons were nausea/malaise (26%) and acute kidney injury (26%). Our hospital re-admission rate was 8.7%. Statistical analysis of the data indicated that home infusion was significantly more likely to result in re-admission compared to the infusion center (p=0.02). Also receiving antibiotics for osteomyelitis was more likely to result in re-admission compared to other diagnoses (p=0.048). Our data indicates that self-administration of antibiotics at home results in higher re-admission rates compared to administration at infusion centers. Factors that may contribute to this difference such as compliance, co-morbidities, or frequency of nurse assessments warrant further exploration to optimize the safety of OPAT, especially in rural South Carolina.},
     year = {2020}
    }
    

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Author Information
  • Department of Medicine, University of South Carolina School of Medicine Greenville, Greenville, USA

  • Department of Medicine, Prisma Health, Greenville, USA

  • Department of Medicine, Prisma Health, Greenville, USA

  • Department of Medicine, Prisma Health, Greenville, USA

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