scholarly journals Perspectives of Patients on Outpatient Parenteral Antimicrobial Therapy: Experiences and Adherence

2020 ◽  
Vol 7 (6) ◽  
Author(s):  
Yasir Hamad ◽  
Sai Dodda ◽  
Allison Frank ◽  
Joe Beggs ◽  
Christopher Sleckman ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Treatment Plan ◽  
Tertiary Hospital ◽  
Antibiotic Administration ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Factors Associated ◽  
Regimen Adherence ◽  
Frequent Administration ◽  
Younger Age ◽  
The Us

Abstract Background Nonadherence to medication is a burden to the US health care system and is associated with poor clinical outcomes. Data on outpatient parenteral antimicrobial therapy (OPAT) treatment plan adherence are lacking. The purpose of this study is to determine the rate of nonadherence and factors associated with it. Methods We surveyed patients discharged from a tertiary hospital on OPAT between February and August 2019 about their baseline characteristics, OPAT regimen, adherence, and experience with OPAT. Results Sixty-five patients responded to the survey. The median age was 62 years, and 56% were male. The rate of reported nonadherence to intravenous (IV) antibiotics was 10%. Factors associated with nonadherence to IV antibiotics included younger age, household income of <$20 000, and lack of time for administering IV antibiotics (30 vs 64 years, P < .01; 83% vs 20%, P < .01, and 33% vs 4%, P = .04, in the nonadherent vs adherent groups, respectively), while less frequent administration (once or twice daily) and having friend or family support during IV antibiotic administration were associated with better adherence (17% vs 76%, P < .01, and 17% vs 66%, P = .03, in the nonadherent vs adherent groups, respectively). Most patients attended their infectious diseases clinic visits (n = 44, 71%), and the most commonly cited reasons for missing an appointment were lacking transportation (n = 12, 60%), not feeling well (n = 8, 40%), and being unaware of the appointment (n = 6, 30%). Conclusions Less frequent antibiotic dosing and better social support were associated with improved adherence to OPAT. In contrast, younger age, lower income, and lack of time were associated with nonadherence.

scholarly journals Paediatric Outpatient Parenteral Antimicrobial Therapy (OPAT): An e-survey of the experiences of parents and clinicians

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249514
Author(s):  
Bernie Carter ◽  
Debra Fisher-Smith ◽  
David Porter ◽  
Steven Lane ◽  
Matthew Peak ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Tertiary Hospital ◽  
Parental Satisfaction ◽  
Hospital Data ◽  
Family Routines ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Open Questions ◽  
Home Based ◽  
Parents And Children ◽  
Paediatric Outpatient

Background Little evidence exists about parental satisfaction and their influence on referral to paediatric Outpatient Parenteral Antimicrobial Therapy (OPAT). Aim This study aimed to examine the experiences of parents, children and clinicians of OPAT at a large tertiary children’s hospital. Method A prospective e-survey, using closed and open questions, of parents (n = 33) of 33 children who had received OPAT (3 children completed a survey), and clinicians (n = 31) involved in OPAT at a tertiary hospital. Data were collected September 2016 to July 2018. Results Data were analysed using simple descriptive statistics. The results show that OPAT offered benefits (less stress, re-establishment of family life) compared to hospital-based treatment for parents and children, although some were anxious. Clinicians’ referral judgements were based on child, home, and clinical factors. Some clinicians found the process of referral complex. Conclusion Most parents and children were satisfied with the OPAT service and preferred the option of home-based treatment as it promoted the child’s comfort and recovery and supported family routines.

scholarly journals Twice daily cefazolin is effective for treatment of serious methicillin-sensitive Staphylococcus aureus infection in an outpatient parenteral antimicrobial therapy program

2019 ◽  
Vol 6 ◽  
pp. 204993611988284 ◽  
Author(s):  
Michael T. Birrell ◽  
Andrew Fuller
Keyword(s):  
Staphylococcus Aureus ◽  
Antimicrobial Therapy ◽  
Vertebral Osteomyelitis ◽  
Tertiary Hospital ◽  
Prosthetic Material ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Therapy Program ◽  
Serious Infections ◽  
Antibiotic Failure ◽  
Mssa Infection

Background: The use of cefazolin for infections caused by Staphylococcus aureus has been demonstrated to be effective, and associated with fewer adverse effects compared with anti-staphylocccal penicillins; however, use of cefazolin on outpatient parenteral antimicrobial therapy (OPAT) programs often requires the use of continuous infusions. We report the outcomes of patients with serious infections caused by methicillin-sensitive S. aureus (MSSA) treated using twice daily cefazolin by a large tertiary hospital OPAT program. The aim of this study was to evaluate the safety, efficacy and outcomes after 90 days of follow up for patients with serious infections caused by MSSA treated with twice daily cefazolin by our OPAT program. Methods: A retrospective analysis of clinical outcomes of cases treated for a serious infection proven to be caused by MSSA treated with cefazolin monotherapy on the OPAT program at a tertiary hospital between January 2010 and July 2016 (6.5 years). Outcome measures included readmission rate, adverse drug reactions and clinical cure. Results: A total of 111 cases of serious MSSA infection were treated with cefazolin in the OPAT service during the study period, including 52 with peripheral or vertebral osteomyelitis and 13 with infective endocarditis; 56 patients had bacteraemia. Median duration of intravenous antibiotic therapy was 41 days, and the median proportion of intravenous therapy administered via OPAT was 69%. Two patients had recurrence of infection within 90 days, but were in the setting of retained prosthetic material. A total of 4% of patients experienced an adverse drug reaction. No cases of antibiotic failure were identified. Conclusions: The use of twice daily cefazolin for serious MSSA infection on an OPAT program is safe and effective. Further study is needed to assess for noninferiority to conventional treatment regimes.

scholarly journals Safety of Nurse- and Self-Administered Paediatric Outpatient Parenteral Antimicrobial Therapy

Antibiotics ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 761
Author(s):  
Shanthy Sriskandarajah ◽  
Brett Ritchie ◽  
Janet K. Sluggett ◽  
Jodie G. Hobbs and Karen J. Reynolds
Keyword(s):  
Antimicrobial Therapy ◽  
Odds Ratio ◽  
Models Of Care ◽  
Clinical Factors ◽  
Self Administration ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Factors Associated ◽  
Infusion Device ◽  
Paediatric Outpatient ◽  
Compare And Contrast

This study aimed to compare and contrast the safety and efficacy of nurse- and self-administered paediatric outpatient parenteral antimicrobial therapy (OPAT) models of care and to identify clinical factors associated with documented adverse events (AEs). A total of 100 OPAT episodes among children aged between 1 month and 18 years who were discharged from hospital and who received continuous 24 h intravenous antimicrobial therapy at home via an elastomeric infusion device were included. All documented AEs from the case notes were reviewed by a paediatrician and classified as either major or minor. Multivariable logistic regression was used to determine associations between clinical factors and any AE. A total of 86 patients received 100 treatment OPAT episodes (49 self-administered, 51 nurse administered). The most commonly prescribed antimicrobial via continuous infusion was ceftazidime (25 episodes). Overall, an AE was recorded for 27 (27%) OPAT episodes. Major AEs was recorded for 15 episodes and minor AEs were reported in 14 episodes. The odds of an AE was increased in episodes with self-administration (adjusted odds ratio (aOR) 6.25, 95% confidence interval (CI) 1.44–27.15) and where the duration of vascular access was >14 days (aOR 1.08, 95%CI 1.01–1.15). Our findings suggest minor AEs may be more frequently reported when intravenous antimicrobials are self-administered via 24 h continuous infusions.

scholarly journals 610. Incidence of Acute Kidney Injury in Outpatient Parenteral Antimicrobial Therapy (OPAT) Patients Receiving Vancomycin

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S366-S366
Author(s):  
Yasir Hamad ◽  
Katelin B Nickel ◽  
Yvonne Burnett ◽  
Margaret A Olsen
Keyword(s):  
Acute Kidney Injury ◽  
Liver Disease ◽  
Antimicrobial Therapy ◽  
Hospital Readmission ◽  
Univariate Analysis ◽  
Kidney Injury ◽  
Research Support ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Factors Associated ◽  
Increased Risk

Abstract Background Vancomycin therapy is known to be associated with nephrotoxicity. Predictors of nephrotoxicity in outpatients are not well defined and have only been reported in relatively small studies. We examined the factors associated with incidence of nephrotoxicity during outpatient parenteral antimicrobial therapy (OPAT) using administrative data. Methods A large insurance claims database of privately insured patients (IBM-MarketScan) ages 18 - 64 from 2010 to 2016 was queried for patients discharged from the hospital on vancomycin OPAT. The primary endpoint was 42-day hospital readmission with acute kidney injury (AKI). A Chi-square test was used to examine associations with AKI. Factors with significant associations in univariate analysis were then incorporated into a multivariable logistic regression model. Results A total of 14,196 patients were included in the study, median age was 54 years and 53.8% were male. Hospital readmission with AKI occurred in 385 (2.7 %). Factors associated with AKI in univariate analysis included older age, living in a rural area, heart failure (CHF), chronic kidney disease (CKD), liver disease, diabetes, cancer, septicemia, MRSA infection, concomitant penicillin therapy, receiving therapy at home versus an infusion center, and infectious diseases consult during index hospitalization. In the multivariable model, septicemia, CHF, CKD, liver disease, and concomitant use of a penicillin family drug were independently associated with increased risk of acute kidney injury (Table). Conclusion Septicemia, use of penicillins and some comorbidities were associated with AKI in patients treated with vancomycin OPAT. Patients at high risk for vancomycin nephrotoxicity should be monitored closely and an alternative therapy should be considered. Table Disclosures Margaret A. Olsen, PhD, MPH, Merck (Grant/Research Support)Pfizer (Consultant, Grant/Research Support)

scholarly journals Applicability of Quality Indicators for Appropriate Antibiotic use in Outpatient Parenteral Antimicrobial Therapy (OPAT): A Point Prevalence Survey

2021 ◽  
Vol 12 ◽  
Author(s):  
Pablo March-López ◽  
Inés Arancibia Freixa ◽  
Mireia Martinez Gil ◽  
Gastón Araujo Espinoza ◽  
Lidia Ortega Polonio ◽  
...  
Keyword(s):  
Quality Indicators ◽  
Antimicrobial Therapy ◽  
Treatment Plan ◽  
Antibiotic Use ◽  
Critical Element ◽  
Dose Frequency ◽  
Prevalence Survey ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Quantitative Indicators

The ability to measure the quality of antibiotic prescription is a critical element in any antimicrobial stewardship programme. The aim of this study was to evaluate the clinimetric properties of 33 quality indicators (QIs) developed to assess Outpatient Parenteral Antimicrobial Therapy (OPAT) and to identify potential room for improvement in a hospital-at-home (HaH) unit. Study performed in a healthcare district in Barcelona, Spain with 260,657 inhabitants, nine primary healthcare centres, a 400-bed acute care teaching hospital, and an HaH unit. We studied 33 QIs on appropriate antibiotic use and classified them as qualitative or quantitative. Quantitative QIs were further categorized as measurable or non-measurable depending on the availability of data in the patients’ medical records. Data from 202 OPAT episodes in 192 patients were assessed. Adherence was found for 22 of the 24 qualitative QIs analyzed; the other two showed room for improvement. Four of the nine quantitative indicators were non-measurable. High adherence rates were achieved for QI-17 “The OPAT plan should be documented” (84.65%), QI-26 “The OPAT treatment plan should include choice, dose, frequency, duration and follow-up plan” (79.70%), and QI-33 “The team should document clinical response” (94.55%). Adverse events were documented in just 1.98% of cases (QI-32) and 92.57% patients were classified as alive on discharge (QI-24). The QIs evaluated were applicable to clinical practice and proved useful for identifying areas with room for improvement in our setting and for guiding the design of future interventions with specific objectives.

Clinical effectiveness of flucloxacillin delivery using an elastomeric device for outpatient parenteral antimicrobial therapy

2020 ◽  
Vol 25 (8) ◽  
pp. 376-380
Author(s):  
Yuhan Zhang ◽  
Yun Chun Ody ◽  
Linsey Davis
Keyword(s):  
Antimicrobial Therapy ◽  
Vertebral Osteomyelitis ◽  
Bloodstream Infections ◽  
Clinical Effectiveness ◽  
Cost Effective ◽  
Antibiotic Administration ◽  
Convenience Sample ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Significant Difference ◽  
Antibiotic Infusion

There has been a surging interest in using elastomeric infusion devices to deliver outpatient parenteral antimicrobial therapy (OPAT), which is more cost-effective than standard antibiotic administration, which requires multiple daily home visits. This has been particularly important since the outbreak of the coronavirus pandemic, because reducing patient contact can also help to minimise transmission of COVID-19 to outpatients who are at a high risk of COVID-19-triggered complications. In this retrospective study, the clinical effectiveness of intravenous (IV) infusion of flucloxacillin using an elastomeric device was explored in a convenience sample of patients. Patients with three primary infective diagnoses—bloodstream infection, non-vertebral osteomyelitis and vertebral osteomyelitis—were included in the analyses. In non-vertebral osteomyelitis patients, Accufuser antibiotic infusion shortened the course of OPAT care relative to standard antibiotic administration (p<.05). In contrast, in vertebral osteomyelitis patients, it prolonged the course of OPAT care relative to standard administration (p<.05). In patients with bloodstream infections, no significant difference was found between the treatment modes (p=.93). Thus, the clinical effectiveness of Accufuser antibiotic infusion varies among patients with different infective diagnoses, and there seems to be a complex relationship between the method of antibiotic delivery and the patient's condition.

scholarly journals Safety and Effectiveness of Outpatient Parenteral Antimicrobial Therapy (OPAT) in the Aged Population

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S331-S332
Author(s):  
Lucinda J Van Anglen ◽  
Richard M Mandel ◽  
Ramesh V Nathan ◽  
Andrew H Krinsky ◽  
Quyen Luu ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Safety Assessment ◽  
Significant Risk ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Aged Population ◽  
Factors Associated ◽  
Disease Characteristics ◽  
Increased Risk ◽  
Catheter Complications ◽  
Common Infections

Abstract Background The aged population (≥75 years) have multiple comorbidities and are at increased risk of adverse events associated with intravenous antimicrobial therapy. Hospitalization (hosp) occurs frequently. This group presents challenges for site of care and reimbursement, which may be met with provision of OPAT through a physician office infusion center (POIC). This setting allows treatment immediately following hosp or directly from the community, thus avoiding hosp. For the aged patient (pt) population, we evaluated safety and effectiveness of OPAT in a POIC. Methods Records from 13 POICs were queried for patients ≥75 years receiving OPAT courses from January to July 2016. Data included demographics, therapy, disease characteristics, effectiveness and safety. Effectiveness was assessed as completion of therapy and no unplanned hosp related to the underlying infection. Safety assessment included adverse drug reactions (ADRs), catheter complications (CC) and hosp admissions for causes other than those related to the underlying infection. Descriptive statistics and regression analyses were performed. Results There were 260 OPAT patient courses provided. Mean age was 81 ± 5 years, 64% male. 51% were treated directly from the community and 49% post hosp. The most common infections were bone and joint (32%), genitourinary (21%), skin and skin structure (20%) and respiratory (12%). OPAT met criteria for effectiveness in 95%, with 247/260 completing therapy and avoiding infection-related hosp. Antimicrobials most frequently used were vancomycin (n = 59), ceftriaxone (n = 43), cefepime (n = 35) and ertapenem (n = 32). Median length of OPAT was 14 days (range 1–79). OPAT was assessed as safe in 81% of patients (211/260). 49 patients reported ≥1 safety events including ADRs (40; 15%), CC (6; 2.3%), and hosp (17; 6.5%). 9 hosp patients completed OPAT following discharge. Most common ADRs were diarrhea (n = 9), fatigue (n = 9) and nausea (n = 8) with 4 hosp for serious ADRs. All CCs resolved and there were no mortalities. Significant risk factors associated with safety events were drug allergies (OR=2.47, CI=1.31–4.65, P = 0.005), ≥3 comorbidities (OR=3.92, CI=1.16–13.23, P = 0.027) and hypertension (OR=2.19, CI=1.04–4.64 P = 0.039). Conclusion Provision of OPAT through a POIC demonstrated to be exceptionally safe and effective in the aged population. Disclosures L. J. Van Anglen, Theravance: Scientific Advisor, Consulting fee R. V. Nathan, Merck: Speaker’s Bureau, Speaker honorarium Allergan: Speaker’s Bureau, Speaker honorarium The Medicines Company: Speaker’s Bureau, Speaker honorarium K. A. Couch, Merck: Speaker’s Bureau, Speaker honorarium Allergan: Speaker’s Bureau, Speaker honorarium

Abstract WMP95: Sociodemographic Factors Associated With Retention of Minorities: Findings From the Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities (SUCCEED) Trial

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Grace Kuo ◽  
Barbara Vickrey ◽  
Frances Barry ◽  
Monica Ayala-Rivera ◽  
Heather McCreath ◽  
...  
Keyword(s):  
Stroke Prevention ◽  
Chronic Care Model ◽  
Chronic Care ◽  
Sociodemographic Characteristics ◽  
Secondary Stroke Prevention ◽  
Care Model ◽  
Factors Associated ◽  
Spanish Speaking ◽  
Younger Age ◽  
The Us

Background: Minority and socioeconomically disadvantaged individuals are underrepresented in secondary stroke prevention trials. Little is known about factors associated with study retention in these populations. Objective: To evaluate the impact of sociodemographic characteristics on retention in the Secondary stroke prevention by Uniting Community and Chronic care model teams Early to End Disparities (SUCCEED) trial. Methods: 487 participants ≥40 years with stroke/TIA were recruited from 4 safety-net hospitals and 1 stroke center serving low income zip codes. Strategies for boosting retention included: having bilingual research assistants from similar cultures establish rapport and follow participants; culturally and linguistically tailoring materials; arranging visits around participants’ schedules; offering transportation, and conducting assessments in the home and community. We compared sociodemographic characteristics among those retained at 12 months (n=412) vs. those not retained (n=75) using t-test, Chi Square, and Fisher exact tests. Independent factors associated with retention were determined using logistic regression. Results: Average age was 57 years, 18% were black, 71% were Hispanic, 58% were Spanish-speaking, and 72% were born outside the US. 12-month retention was 85%. On bivariate analysis, factors associated with retention were: Spanish-speaking, Hispanic ethnicity, younger age, born outside the US, and married status (all p<0.05). After multivariate analysis, study site, younger age (<64 vs ≥65 years OR 2.2, 95% CI 1.1,4.4), married status (OR 2.0, 1.0,4.2), government insurance (vs uninsured OR 25.1, 1.2,5.1), private insurance (vs uninsured, OR 4.6, 1.3,16.4), and inability to afford medical care (OR 2.9, 1.3,6.7) were associated with retention. Discussion: In this secondary prevention trial of stroke survivors from predominantly minority backgrounds, younger age, marriage, and insurance were associated with retention, suggesting that addressing barriers in the elderly, and those without insurance or spousal support may be beneficial. Financial constraints were associated with retention suggesting that study participation appealed to more socioeconomically vulnerable individuals.

scholarly journals Emergency Department Visits During Outpatient Parenteral Antimicrobial Therapy: A Cohort Study

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S333-S334
Author(s):  
So Lim Kim ◽  
Angela Everett ◽  
Susan J Rehm ◽  
Steven Gordon ◽  
Nabin Shrestha
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Hospital Admission ◽  
Vascular Access ◽  
Antimicrobial Therapy ◽  
Cleveland Clinic ◽  
Emergency Department Visits ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Ed Visits ◽  
Access Complications

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) carries risk of vascular access complications, antimicrobial adverse effects, and worsening of infection. Both OPAT-related and unrelated events may lead to emergency department (ED) visits. The purpose of this study was to describe adverse events that result in ED visits and risk factors associated with ED visits during OPAT. Methods OPAT courses between January 1, 2013 and December 31, 2016 at Cleveland Clinic were identified from the institution’s OPAT registry. ED visits within 30 days of OPAT initiation were reviewed. Reasons and potential risk factors for ED visits were sought in the medical record. Results Among 11,440 OPAT courses during the study period, 603 (5%) were associated with 1 or more ED visits within 30 days of OPAT initiation. Mean patient age was 58 years and 57% were males. 379 ED visits (49%) were OPAT-related; the most common visit reason was vascular access complication, which occurred in 211 (56%) of OPAT-related ED visits. The most common vascular access complications were occlusion and dislodgement, which occurred in 99 and 34 patients (47% and 16% of vascular access complications, respectively). In a multivariable logistic regression model, at least one prior ED visit in the preceding year (prior ED visit) was most strongly associated with one or more ED visits during an OPAT course (OR 2.96, 95% CI 2.38 – 3.71, p-value &lt; 0.001). Other significant factors were younger age (p 0.01), female sex (p 0.01), home county residence (P &lt; 0.001), and having a PICC (p 0.05). 549 ED visits (71%) resulted in discharge from the ED within 24 hours, 18 (2%) left against medical advice, 46 (6%) were observed up to 24 hours, and 150 ED visits (20%) led to hospital admission. Prior ED visit was not associated with hospital admission among patients who visited the ED during OPAT. Conclusion OPAT-related ED visits are most often due to vascular access complications, especially line occlusions. Patients with a prior ED visit in the preceding year have a 3-fold higher odds of at least one ED visit during OPAT compared with patients without a prior ED visit. A strategy of managing occlusions at home and a focus on patients with prior ED visits could potentially prevent a substantial proportion of OPAT-related ED visits. Disclosures All authors: No reported disclosures.

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