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Outpatient Parenteral Antimicrobial Therapy Practices among Adult Infectious Disease Physicians

Published online by Cambridge University Press:  10 May 2016

Michael A. Lane ,
Jonas Marschall ,
Susan E. Beekmann ,
Philip M. Polgreen ,
Ritu Banerjee ,
Adam L. Hersh  and
Hilary M. Babcock
Michael A. Lane*
Affiliation:
Department of Internal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
Jonas Marschall
Affiliation:
Department of Internal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
Susan E. Beekmann
Affiliation:
Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
Philip M. Polgreen
Affiliation:
Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
Ritu Banerjee
Affiliation:
Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
Adam L. Hersh
Affiliation:
Pediatric Infectious Diseases, University of Utah, Salt Lake City, Utah
Hilary M. Babcock
Affiliation:
Department of Internal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
*
Washington University School of Medicine, Campus Box 8051, 660 South Euclid Avenue, St. Louis, MO 63110 (mlane@dom.wustl.edu).
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Extract

Objective

To identify current outpatient parenteral antibiotic therapy practice patterns and complications.

Methods

We administered an 11-question survey to adult infectious disease physicians participating in the Emerging Infections Network (EIN), a Centers for Disease Control and Prevention–sponsored sentinel event surveillance network in North America. The survey was distributed electronically or via facsimile in November and December 2012. Respondent demographic characteristics were obtained from EIN enrollment data.

Results

Overall, 555 (44.6%) of EIN members responded to the survey, with 450 (81%) indicating that they treated 1 or more patients with outpatient parenteral antimicrobial therapy (OPAT) during an average month. Infectious diseases consultation was reported to be required for a patient to be discharged with OPAT by 99 respondents (22%). Inpatient (282 [63%] of 449) and outpatient (232 [52%] of 449) infectious diseases physicians were frequently identified as being responsible for monitoring laboratory results. Only 26% (118 of 448) had dedicated OPAT teams at their clinical site. Few infectious diseases physicians have systems to track errors, adverse events, or “near misses” associated with OPAT (97 [22%] of 449). OPAT-associated complications were perceived to be rare. Among respondents, 80% reported line occlusion or clotting as the most common complication (occurring in 6% of patients or more), followed by nephrotoxicity and rash (each reported by 61%). Weekly laboratory monitoring of patients who received vancomycin was reported by 77% of respondents (343 of 445), whereas 19% of respondents (84 of 445) reported twice weekly laboratory monitoring for these patients.

Conclusions

Although use of OPAT is common, there is significant variation in practice patterns. More uniform OPAT practices may enhance patient safety.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 7 , July 2014 , pp. 839 - 844
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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References

1. Leder, K, Turnidge, JD, Grayson, ML. Home-based treatment of cellulitis with twice-daily cefazolin. Med J Aust 1998;169(10):519–522.CrossRefGoogle ScholarPubMed
2. Nathwani, D. The management of skin and soft tissue infections: outpatient parenteral antibiotic therapy in the United Kingdom. Chemotherapy 2001;47(suppl 1):17–23.CrossRefGoogle ScholarPubMed
3. Eron, LJ, Goldenberg, RI, Poretz, DM. Combined ceftriaxone and surgical therapy for osteomyelitis in hospital and outpatient settings. Am J Surg 1984;148(4A):1–4.Google ScholarPubMed
4. Tice, AD. Outpatient parenteral antimicrobial therapy for osteomyelitis. Infect Dis Clin North Am 1998;12(4):903–919.CrossRefGoogle ScholarPubMed
5. Esposito, S, Noviello, S, Leone, S, et al. Outpatient parenteral antibiotic therapy (OPAT) in different countries: a comparison. Int J Antimicrob Agents 2004;24(5):473–478.CrossRefGoogle ScholarPubMed
6. Duggal, A, Barsoum, W, Schmitt, SK. Patients with prosthetic joint infection on IV antibiotics are at high risk for readmission. Clin Orthop Relat Res 2009;467(7):1727–1731.CrossRefGoogle ScholarPubMed
7. Rehm, SJ. Outpatient intravenous antibiotic therapy for endocarditis. Infect Dis Clin North Am 1998;12(4):879–901, vi.CrossRefGoogle ScholarPubMed
8. Chary, A, Tice, AD, Martinelli, LP, Liedtke, LA, Plantenga, MS, Strausbaugh, LJ. Experience of infectious diseases consultants with outpatient parenteral antimicrobial therapy: results of an emerging infections network survey. Clin Infect Dis 2006;43(10):1290–1295.CrossRefGoogle ScholarPubMed
9. Montalto, M. Patients’ and carers’ satisfaction with hospital-in-the-home care. Int J Qual Health Care 1996;8(3):243–251.CrossRefGoogle ScholarPubMed
10. Hindes, R, Winkler, C, Kane, P, Kunkel, M. Outpatient intravenous antibiotic therapy in medicare patients: cost-savings analysis. Infect Dis Clin Pract 1995;4(3):211–217.CrossRefGoogle Scholar
11. Poretz, DM, Woolard, D, Eron, LJ, Goldenberg, RI, Rising, J, Sparks, S. Outpatient use of ceftriaxone: a cost-benefit analysis. Am J Med 1984;77(4C):77–83.Google ScholarPubMed
12. Williams, DN, Bosch, D, Boots, J, Schneider, J. Safety, efficacy, and cost savings in an outpatient intravenous antibiotic program. Clin Ther 1993;15(1):169–179; discussion 168.Google Scholar
13. Tice, AD, Rehm, SJ, Dalovisio, JR, et al. Practice guidelines for outpatient parenteral antimicrobial therapy. IDSA guidelines. Clin Infect Dis 2004;38(12):1651–1672.CrossRefGoogle ScholarPubMed
14. Executive Committee of the Infectious Diseases Society of America Emerging Infections Network. The emerging infections network: a new venture for the Infectious Diseases Society of America. Clin Infect Dis 1997;25(1):34–36.CrossRefGoogle Scholar
15. US Department of Commerce. Census regions and divisions of the United States. http://www.census.gov/geo/maps-data/maps/pdfs/reference/us_regdiv.pdf. Accessed May 1, 2014.Google Scholar
16. Chapman, AL, Seaton, RA, Cooper, MA, et al. Good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) in adults in the UK: a consensus statement. J Antimicrob Chemother 2012;67(5):1053–1062.CrossRefGoogle ScholarPubMed
17. Sharma, R, Loomis, W, Brown, RB. Impact of mandatory inpatient infectious disease consultation on outpatient parenteral antibiotic therapy. Am J Med Sci 2005;330(2):60–64.CrossRefGoogle ScholarPubMed
18. Shrestha, NK, Bhaskaran, A, Scalera, NM, Schmitt, SK, Rehm, SJ, Gordon, SM. Contribution of infectious disease consultation toward the care of inpatients being considered for community-based parenteral anti-infective therapy. J Hosp Med 2012;7(5):365–369.CrossRefGoogle ScholarPubMed
19. Tice, AD. Outpatient parenteral antibiotic therapy (OPAT) in the United States: delivery models and indications for use. Can J Infect Dis 2000;11(suppl A):17A–21A.Google Scholar
20. Berman, SJ, Johnson, EW. Out-patient parenteral antibiotic therapy (OPAT): clinical outcomes and adverse events. Hawaii Med J 2001;60(2):31–33.Google ScholarPubMed
21. Tice, A. The use of outpatient parenteral antimicrobial therapy in the management of osteomyelitis: data from the Outpatient Parenteral Antimicrobial Therapy Outcomes Registries. Chemotherapy 2001;47(suppl 1):5–16.CrossRefGoogle ScholarPubMed
22. Tice, AD, Hoaglund, PA, Nolet, B, McKinnon, PS, Mozaffari, E. Cost perspectives for outpatient intravenous antimicrobial therapy. Pharmacotherapy 2002;22(2 pt 2):63S–70S.CrossRefGoogle ScholarPubMed
23. Rehm, SJ, Longworth, DL. Rates of adverse events associated with community-based parenteral anti-infective therapy. J Clin Outcomes Manage 2000;7(10):23–28.Google Scholar
24. Cervera, C, del Rio, A, Garcia, L, et al. Efficacy and safety of outpatient parenteral antibiotic therapy for infective endocarditis: a ten-year prospective study. Enferm Infecc Microbiol Clin 2011;29(8):587–592.CrossRefGoogle ScholarPubMed
25. Elyasi, S, Khalili, H, Dashti-Khavidaki, S, Mohammadpour, A. Vancomycin-induced nephrotoxicity: mechanism, incidence, risk factors and special populations: a literature review. Eur J Clin Pharmacol 2012;68(9):2143–2155.CrossRefGoogle ScholarPubMed
26. Rybak, M, Lomaestro, B, Rotschafer, JC, et al. Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm 2009;66(1):82–98.CrossRefGoogle Scholar
27. van Hal, SJ, Paterson, DL, Lodise, TP. Systematic review and meta-analysis of vancomycin-induced nephrotoxicity associated with dosing schedules that maintain troughs between 15 and 20 milligrams per liter. Antimicrob Agent Chemother 2013;57(2):734–744.CrossRefGoogle ScholarPubMed