scholarly journals Patient Characteristics and Outcomes of Outpatient Parenteral Antimicrobial Therapy: A Retrospective Study

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Marie Yan ◽  
Marion Elligsen ◽  
Andrew E. Simor ◽  
Nick Daneman
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Therapy ◽  
Retrospective Chart Review ◽  
Surgical Site Infections ◽  
Patient Characteristics ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Health Care Encounters ◽  
One Year ◽  
Alternative To Hospitalization

Outpatient parenteral antimicrobial therapy (OPAT) is a safe and effective alternative to hospitalization for many patients with infectious diseases. The objective of this study was to describe the OPAT experience at a Canadian tertiary academic centre in the absence of a formal OPAT program. This was achieved through a retrospective chart review of OPAT patients discharged from Sunnybrook Health Sciences Centre within a one-year period. Between June 2012 and May 2013, 104 patients (median age 63 years) were discharged home with parenteral antimicrobials. The most commonly treated syndromes included surgical site infections (33%), osteoarticular infections (28%), and bacteremia (21%). The most frequently prescribed antimicrobials were ceftriaxone (21%) and cefazolin (20%). Only 56% of the patients received follow-up care from an infectious diseases specialist. In the 60 days following discharge, 43% of the patients returned to the emergency department, while 26% required readmission. Forty-eight percent of the return visits were due to infection relapse or treatment failure, and 23% could be attributed to OPAT-related complications. These results suggest that many OPAT patients have unplanned health care encounters because of issues related to their infection or treatment, and the creation of a formal OPAT clinic may help improve outcomes.

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

2018 Infectious Diseases Society of America Clinical Practice Guideline for the Management of Outpatient Parenteral Antimicrobial Therapya

2018 ◽  
Vol 68 (1) ◽  
pp. 1-4 ◽  
Author(s):  
Anne H Norris ◽  
Nabin K Shrestha ◽  
Genève M Allison ◽  
Sara C Keller ◽  
Kavita P Bhavan ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Healthcare Professionals ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Infusion Catheter

Abstract A panel of experts was convened by the Infectious Diseases Society of America to update the 2004 clinical practice guideline on outpatient parenteral antimicrobial therapy (OPAT) [1]. This guideline is intended to provide insight for healthcare professionals who prescribe and oversee the provision of OPAT. It considers various patient features, infusion catheter issues, monitoring questions, and antimicrobial stewardship concerns. It does not offer recommendations on the treatment of specific infections. The reader is referred to disease- or organism-specific guidelines for such support.

scholarly journals P64 Implementation of a paediatric outpatient parenteral antibiotic therapy (p-OPAT) service at a specialist children’s hospital

2020 ◽  
Vol 105 (9) ◽  
pp. e39.2-e40
Author(s):  
Hannah Porter ◽  
Kate Stock
Keyword(s):  
Data Collection ◽  
Antibiotic Therapy ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
List Type ◽  
Parenteral Antibiotic ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Paediatric Outpatient ◽  
Bed Days ◽  
One Year

AimThe aim of this project is to optimise patient care, enhance patient experience, improve antimicrobial stewardship and assist patient flow through the hospital.MethodData collection was conducted one day a week over five consecutive weeks. All eligible wards were visited. Patient medication charts were inspected to see if intravenous antimicrobials were prescribed and a patient - specific data collection form was then completed. All the patients that met the eligibility criteria to be put forward for OPAT referral were then considered from a clinical perspective by a paediatric consultant as to their suitability for OPAT or IVOST and discharge. If the patient was deemed suitable for an OPAT discharge or IVOST and discharge a decision was made as to what antimicrobials they would theoretically have been on when discharged home. The number of potential bed days saved was calculated as the number of days between the patients review by the consultant (ie the day of data collection) and the date of their discharge prescription from that episode of care.The following was examinedpercentage of patients with identified pathogenspercentage of patients that had received input from the ID teampercentage of patients that had received input from microbiologythe prevalence of antimicrobials prescribedthe location of the patient’s home residencepatient/parent willingness to go home on OPAT.The data for patient numbers and bed day savings was then extrapolated to 52 weeks in order to be indicative of one year.ResultsOver the five days, 66 patients were identified that met the exclusion criteria to be referred for OPAT or IVOST. After clinical consideration the consultant deemed 4 patients to be suitable for OPAT and 19 for IVOST and discharge which generated a potential bed day saving of 38 bed days. This was comprised of 17 days through providing IVAs via OPAT and 21 days from timelier IVOST and discharge of patients. Extrapolated to be representative of one year, this would be a bed saving to the Trust of 1, 976 bed days.ConclusionThe potential has been identified for the hospital to make considerable bed day savings through the investment in an extended antimicrobial stewardship programme and establishment of a paediatric OPAT service. A business case has been submitted to the hospital board for consideration, with the hope that the service will be funded for a six month probationary period in order to assess its impact over the winter months, when demand for beds and pressures on PICU and theatres are highest.ReferencesPatel S, et al. 2015. Good practice recommendations for paediatric outpatient parenteral antibiotic therapy (p-OPAT) in the UK: a consensus statement. Journal of Antimicrobial Chemotherapy2015;702:360–373.Carter B, et al. Delivery, setting and outcomes of paediatric outpatient parenteral antimicrobial therapy (OPAT): a scoping review. BMJ Open, 2018;8:e021603.Hodgson KA, et al. The use, appropriateness and outcomes of outpatient parenteral antimicrobial therapy. Archives of Disease in Childhood, 2016:10:886–893.Knackstedt ED, et al. Outpatient parenteral antimicrobial therapy in pediatrics: an opportunity to expand antimicrobial stewardship. Infection Control & Hospital „Epidemiology 2015:36:222–224.

Close Patient Follow-up Among Patients Receiving Outpatient Parenteral Antimicrobial Therapy

2019 ◽  
Vol 70 (1) ◽  
pp. 67-74 ◽  
Author(s):  
Danielle L Palms ◽  
Jesse T Jacob
Keyword(s):  
Logistic Regression ◽  
Antimicrobial Therapy ◽  
Care Transitions ◽  
Clinic Visit ◽  
Outpatient Setting ◽  
Multivariate Logistic Regression Model ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Charlson Comorbidity Score ◽  
Pathogen Diagnosis

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) programs allow patients to receive intravenous treatment in the outpatient setting. We developed a predictive model of 30-day readmission among hospitalized patients discharged on OPAT from 2 academic medical centers with a dedicated OPAT clinic for management. Methods A retrospective medical records review was performed and logistic regression was used to assess OPAT and other outpatient clinic follow-up in conjunction with age, sex, pathogen, diagnosis, discharge medication, planned length of therapy, and Charlson comorbidity score. We hypothesized that at least 1 follow-up visit at the Emory OPAT clinic would reduce the risk for hospital readmission within 30 days. Results Among 755 patients, 137 (18%) were readmitted within 30 days. Most patients (73%) received outpatient follow-up care at Emory Healthcare within 30 days of discharge or prior to readmission, including 52% of patients visiting the OPAT clinic. The multivariate logistic regression model indicated that a follow-up OPAT clinic visit was associated with lower readmission compared to those who had no follow-up visit (odds ratio, 0.10 [95% confidence interval, .06–.17]) after adjusting for infection with enterococci, Charlson score, discharge location, and county of residence. Conclusions These results can inform potential interventions to prevent readmissions through OPAT clinic follow-up and to further assess factors associated with successful care transitions from the inpatient to outpatient setting.

scholarly journals Combined Topical and Oral Antimicrobial Therapy for the Eradication of Methicillin-ResistantStaphylococcus aureus(Mrsa) Colonization in Hospitalized Patients

2002 ◽  
Vol 13 (5) ◽  
pp. 287-292 ◽  
Author(s):  
Scott K Fung ◽  
Marie Louie ◽  
Andrew E Simor
Keyword(s):  
Medical Devices ◽  
Antimicrobial Therapy ◽  
Chart Review ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Hospitalized Patients ◽  
Urinary Catheters ◽  
Mupirocin Ointment ◽  
Mrsa Colonization

OBJECTIVE: How to eradicate methicillin-resistantStaphylo-coccus aureus(MRSA) colonization in hospitalized patients is uncertain. We reviewed our experience with MRSA decolonization therapy in hospitalized patients.SETTING: An 1100-bed, university-affiliated tertiary care teaching hospital in Toronto, Ontario.DESIGN: Retrospective chart review of 207 adult inpatients with MRSA colonization hospitalized between February 1996 and March 1999.INTERVENTIONS: All patients with MRSA colonization were assessed for possible decolonization therapy with a combination of 4% chlorhexidine soap for bathing and washing, 2% mupirocin ointment applied to the anterior nares three times/day, rifampin (300 mg twice daily) and either trimethoprim/sulfamethoxazole (160 mg/800 mg twice daily) or doxycycline (100 mg twice daily). This treatment was given for seven days.RESULTS: A total of 207 hospitalized patients with MRSA colonization were identified and 103 (50%) received decolonization therapy. Patients who received decolonization therapy were less likely than untreated patientsto have intravenous (P=0.004) or urinary catheters (P<0.001), or extranasal sites of colonization (P=0.001). Successful decolonization was achieved in 90% of the 43 patients who were available for at least three months of follow-up.CONCLUSIONS: Combined topical and oral antimicrobial therapy was found to be effective in eradicating MRSA colonization in selected hospitalized patients, especially those without indwelling medical devices or extranasal sites of colonization.

scholarly journals Incidence of surgical-site infections in orthopaedic surgery: a northern Italian experience

2010 ◽  
Vol 139 (5) ◽  
pp. 777-782 ◽  
Author(s):  
A. CASTELLA ◽  
P. A. ARGENTERO ◽  
E. C. FARINA ◽  
L. CHARRIER ◽  
E. M. BRACH DEL PREVER ◽  
...  
Keyword(s):  
Surgical Site Infections ◽  
Public Hospitals ◽  
Surveillance Systems ◽  
Knee Prostheses ◽  
Surveillance Period ◽  
Italian Experience ◽  
Italian Regions ◽  
Post Operation ◽  
One Year

SUMMARYA prospective cohort study with a 1-year telephone follow-up was performed to estimate the incidence of surgical-site infections (SSIs) in hip and knee prostheses. Twenty-five public hospitals equipped with orthopaedic units in two Italian regions were involved. An 8-month surveillance period was set to obtain significant data at a regional level and data were collected by the infection control nurses of each centre. One-year follow-up was completed in 75% of cases. SSIs were recorded in 45 cases (incidence rate 1·9/100 person-years, 95% CI 1·4–2·5). Thirty-six percent of SSIs were diagnosed during hospitalization and 95·3% within 90 days post-operation. This incidence is similar to that reported by European and USA surveillance systems. The proposed investigative method proved to be reliable and feasible. A prolonged surveillance for at least 3 months post-operation yields a good estimate of SSI in joint replacements.

scholarly journals Submuscular plates versus flexible nails in preadolescent diaphyseal femur fractures

2018 ◽  
Vol 12 (5) ◽  
pp. 488-492 ◽  
Author(s):  
L.-K. Chen ◽  
B. T. Sullivan ◽  
P. D. Sponseller
Keyword(s):  
Operative Time ◽  
Length Of Hospital Stay ◽  
Surgical Site Infections ◽  
Patient Characteristics ◽  
Level Of Evidence ◽  
Femur Fractures ◽  
Estimated Blood Loss ◽  
Postoperative Length ◽  
Flexible Nails

Purpose To compare patient characteristics, operative time, estimated blood loss (EBL), postoperative length of hospital stay (LOS) and complications after insertion and removal of submuscular plates (SMPs) versus flexible nails (FNs) for paediatric diaphyseal femur fractures. Methods We reviewed records of 58 children (mean age, 7.7 years SD 2.0) with diaphyseal femur fractures who underwent treatment with SMPs (n = 30) or FNs (n = 28) from 2005 to 2017 (mean follow-up, 22 months SD 28). Patients with pathological fractures or musculoskeletal comorbidities were excluded. Alpha = 0.05. Results Insertion of FNs was associated with shorter operative time (ß = –24 mins) and less EBL (ß = –38 mL) (both, p < 0.001) compared with insertion of SMPs, after adjusting for fracture type and time from beginning of study period. Removal of FNs was also associated with shorter operative time (ß = –15 min) compared with removal of SMPs (p < 0.001). EBL during removal was similar between groups (p = 0.080). The FN group had a shorter LOS after insertion (ß = –0.2 d) compared with the SMP group (p = 0.032). Four patients treated with SMPs and three treated with FNs developed surgical site infections. Two patients treated with SMPs and seven treated with FNs experienced implant irritation that resolved with removal. No other complications occurred. Conclusion Compared with SMPs, FNs were associated with shorter operative time (for insertion and removal), less EBL (for insertion) and shorter post-insertion LOS in patients with diaphyseal femur fractures. Level of Evidence: III

scholarly journals Therapeutic Challenges for Elderly Patients with Primary Hyperparathyroidism

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Kenneth Sluis ◽  
Hyon Kim ◽  
Yuling He ◽  
Beatrice Wong ◽  
Xiangbing Wang
Keyword(s):  
Primary Hyperparathyroidism ◽  
Chart Review ◽  
Treatment Options ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Long Term Stability ◽  
Feasible Option ◽  
One Year

Primary hyperparathyroidism (PHPT) predominantly affects older adults, and parathyroidectomy can achieve definitive cure in symptomatic PHPT and asymptomatic meeting surgical criteria. As the population continues to age, the treatment of PHPT in octogenarians and nonagenarians presents a clinical conundrum. This case series presents the management of eight patients 85 years of age and older diagnosed with PHPT. A retrospective chart review of patients diagnosed with primary hyperparathyroidism were identified in a single institution. Those patients 85 years of age and older who were followed up for over one year were included in this case series. The literature on treatment options for this age group was also reviewed. Eight cases of PHPT patients aged 88 ± 2.5 years old with a follow-up average of 5.6 ± 4.4 years were reported in our case series. Six PHPT patients were medically managed and two PHPT patients underwent parathyroid resection. Most of the medically managed PHPT patients except for one had long-term stability of disease for over five years. The treatment of PHPT diagnosed in patients over 85 years of age presents a clinical challenge for which there is no clear consensus guideline. Our case series supports that medical therapy is a feasible option for PHPT patients over 85 years old.

Intermediate and Long-term Outcomes Following Surgical Decompression of Neurogenic Thoracic Outlet Syndrome in an Adolescent Patient Population

Hand ◽  
2020 ◽  
pp. 155894471990131
Author(s):  
Erin F. Ransom ◽  
Heather L. Minton ◽  
Bradley L. Young ◽  
Jun Kit He ◽  
Brent A. Ponce ◽  
...  
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Patient Reported Outcome ◽  
Long Term Outcomes ◽  
Neurogenic Thoracic Outlet Syndrome ◽  
Patient Reported ◽  
Data Points

Background: Although the diagnosis of thoracic outlet syndrome (TOS) is often missed, outcomes from surgical intervention significantly improve patient satisfaction. This article seeks to highlight patient characteristics, intraoperative findings, and both short and long-term outcomes of thoracic outlet decompression in the adolescent population. Methods: A retrospective chart review of patients between the ages of 13 and 21 years with a clinical diagnosis of neurogenic thoracic outlet syndrome (NTOS) who were treated surgically between 2000 and 2015 was performed. Data points including preoperative patient characteristics and intraoperative findings were collected. In addition, patient-reported outcome scores, including Visual Analog Scale (VAS), Single Assessment Numeric Evaluation (SANE), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire, Cervical Brachial Symptom Questionnaire (CBSQ), and NTOS index, were obtained for a cohort of patients with follow-up ranging from 2 to 15 years. Results: The study population consisted of 54 patients involving 61 extremities. The most common procedures included neurolysis of the supraclavicular brachial plexus (60, 98.4%), anterior scalenectomy (59, 96.7%), and middle scalenectomy (54, 88.5%). First rib resection (FRR) was performed in 28 patients (45.9%). Long-term outcomes were collected for 24 (44%) of 54 patients with an average follow-up of 69.5 months (range, 24-180 months). The average VAS improved from 7.5 preoperatively to 1.8 postoperatively. The average SANE increased from 28.9 preoperatively to 85.4 postoperatively. The average postoperative scores were 11.4 for the QuickDASH, 27.4 for the CBSQ, and 17.2 for the NTOS index. Subgroup analysis of patients having FRR (28, 45.9%) demonstrated no difference in clinical outcome measures compared with patients who did not have FRR. Conclusion: Surgical treatment of NTOS in adolescent patients has favorable intermediate and long-term outcomes.

scholarly journals 1134. Substance Use Disorder Patients’ Perspectives of a Multidisciplinary Antimicrobial Infusion Service

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S596-S596
Author(s):  
Joy J Juskowich ◽  
Clinton G Cooper ◽  
Ruchi Bhandari ◽  
Stephanie S Boyd ◽  
Neil Reece ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Substance Use ◽  
Infectious Diseases ◽  
Substance Use Disorder ◽  
Antimicrobial Therapy ◽  
Addiction Treatment ◽  
Healthcare Providers ◽  
Injection Drugs ◽  
Addiction Therapy

Abstract Background Injection drug use is associated with infectious diseases such as endocarditis and osteomyelitis requiring prolonged intravenous (IV) antimicrobial therapy. Few programs offer simultaneous inpatient infectious disease and addiction treatment. WVU Medicine implemented a multidisciplinary Infusion Service (IS) to provide IV antimicrobial therapy while treating substance use disorder. From 2017 through 2019, IS cared for over 840 patients. The aim of this study was to evaluate IS by assessing patients’ perspectives of overall experience, interactions with healthcare providers, and preparation for continued recovery from substance use. Methods Adults ≥ 18 and &lt; 90 years-old with substance use disorder on IS between November 2019 and May 2020 were eligible. Demographic, substance use, and infectious diseases data were obtained by chart review. Confidential surveys with questions about overall experience, interactions with healthcare providers, and preparation for continued recovery were administered during the first week after transfer to IS and again the week of discharge. Results Forty-two patients completed 39 initial and 12 follow up surveys. All used injection drugs, 85.7% (36/42) used opioids and 66.7% (28/42) used methamphetamine. Endocarditis was most common infection (61.9% (26/42)), with Staphylococcus aureus most often isolated (59.5% (25/42)). IS experience and care for infection were excellent or good in 97.4% (38/39) initial and 100% (12/12) follow up surveys. During IS, patients did not perceive being treated differently due to substance use in 94.9% (37/39) initial and 83.3% (10/12) follow up surveys. Before IS, patients perceived being treated differently in 84.6% (33/39) initial and 100% (12/12) follow up surveys. Patients felt IS would help with continued recovery in 84.6% (33/39) initial and 100% (12/12) follow up surveys. Conclusion According to patients’ perspectives, IS is effective in creating a positive overall healthcare experience, reducing stigma associated with substance use, and preparing patients for continued recovery after discharge. This study supports combining inpatient infectious disease and addiction therapy. Infectious diseases providers should be educated about this multidisciplinary approach. Disclosures All Authors: No reported disclosures

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