Outpatient parenteral antimicrobial therapy is safe and effective for the treatment of infective endocarditis: a retrospective cohort study

2013 ◽  
Vol 43 (6) ◽  
pp. 700-705 ◽  
Author(s):  
A. K. F. Htin ◽  
N. D. Friedman ◽  
A. Hughes ◽  
D. P. O'Brien ◽  
S. Huffam ◽  
...  
Keyword(s):  
Cohort Study ◽  
Infective Endocarditis ◽  
Antimicrobial Therapy ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Outpatient Parenteral Antimicrobial Therapy

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

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.

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

2017 ◽  
Vol 94 (1107) ◽  
pp. 25-31 ◽  
Author(s):  
Michael Quirke ◽  
Emma May Curran ◽  
Patrick O’Kelly ◽  
Ruth Moran ◽  
Eimear Daly ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Cohort Study ◽  
Antimicrobial Therapy ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Adult Patients ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Cart Analysis ◽  
Cart Algorithm

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.

scholarly journals Blood culture time to positivity in non-β-hemolytic streptococcal bacteremia as a predictor of infective endocarditis—a retrospective cohort study

2021 ◽  
Author(s):  
David Krus ◽  
Fredrik Kahn ◽  
Bo Nilson ◽  
Torgny Sunnerhagen ◽  
Magnus Rasmussen
Keyword(s):  
Cohort Study ◽  
Infective Endocarditis ◽  
Blood Culture ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Population Based ◽  
Culture Time ◽  
Time To Positivity

AbstractNon-β-hemolytic streptococci (NBHS) cause infective endocarditis (IE) and a short blood culture time to positivity (TTP) is associated with risk of IE in bacteremia with other pathogens. In this retrospective population-based cohort study, we investigate if TTP is associated to IE or mortality. Of 263 episodes with NBHS bacteremia, 28 represented IE and the median TTP did not differ significantly between episodes with IE (15 h) and non-IE (15 h) (p=0.51). TTP was similar among those who survived and those who died within 30 days. However, TTP significantly differed when comparing the different streptococcal groups (p<0.001).

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