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Original Article

Clinical Outcomes of a Veterans Affairs Outpatient Antimicrobial Treatment Program

Shahrzad Mohammadi, BS, MPH, Kimberly MacKay, PharmD, Thomas T. Ward, MD, Graeme N. Forrest, MBBS
Volume: 106 Issue: 6 June, 2013

Abstract:

Objectives: The outpatient parenteral antibiotic therapy (OPAT) program of the Portland Veterans Affairs Medical Center (PVAMC), which has a self-administration model, is staffed by visiting nurses from a specialist infusion company. This study evaluates the clinical outcomes of these patients.

Methods: This study was a retrospective chart review of 262 patients at PVAMC who had received OPAT between 2007 and 2009. Patients were included only if they received ongoing care at PVAMC. The data collected included conditions and organisms being treated and types and durations of antibiotics used. Clinical cure was defined as documented cure at the end of treatment and 90 days post-OPAT.

Results: One hundred ninety patients of 262 were analyzed. The mean age was 63.2 years. Diabetes was the main comorbid factor (17%). The most common indications for OPAT were osteomyelitis (38%), urinary tract infection (23%), and skin and soft tissue infection (12.6%). Mixed bacterial culture (26%) and Staphylococcus aureus (31%) were the most common organisms treated. Vancomycin was the most frequently used antibiotic (26%) followed by ceftriaxone (12%). The median duration of OPAT was 30 days. The rate of clinical cure at end of treatment observed for all infections treated was 78%, which then decreased to 58% at 90 days post-OPAT (P < 0.001). Patients with diabetes and osteomyelitis had an increased risk of relapse at 90 days post-OPAT on multivariate analysis (P = 0.025).

Conclusions: An OPAT program using a self-administration model treating patients who were military veterans had successful outcomes. Patients with diabetes and osteomyelitis had worse clinical outcomes 90 days after the completion of OPAT therapy.

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References:

1. Tice AD, Rehm SJ, Dalovisio JR, et al. Practice guidelines for outpatient parenteral antimicrobial therapy. IDSA guidelines. Clin Infect Dis. 2004; 38: 1651–1672.
 
2. Cox AM, Malani PN, Wiseman SW, et al. Home intravenous antimicrobial infusion therapy: a viable option in older adults. J Am Geriatr Soc. 2007; 55: 645–650.
 
3. Tice AD. The importance of teamwork for outpatient parenteral antibiotic therapy. Int J Antimicrob Agents. 1995; 5: 13–17.
 
4. Slavik RS, Jewesson PJ. Selecting antibacterials for outpatient parenteral antimicrobial therapy: pharmacokinetic-pharmacodynamic considerations. Clin Pharmacokinet. 2003; 42: 793–817.
 
5. Paladino JA, Poretz D. Outpatient parenteral antimicrobial therapy today. Clin Infect Dis. 2010; 51: S198–S208.
 
6. Larioza J, Heung L, Girard A, et al. Management of infective endocarditis in outpatients: clinical experience with outpatient parenteral antibiotic therapy. South Med J. 2009; 102: 575–579.
 
7. Monteiro CA, Cobbs CG. Outpatient management of infective endocarditis. Curr Infect Dis Rep. 2001; 3: 319–327.
 
8. Lipsky BA, Peters EJ, Senneville E, et al. Expert opinion on the management of infections in the diabetic foot. Diabetes Metab Res Rev. 2012; 28: 163–178.
 
9. Tice AD. Ertapenem: a new opportunity for outpatient parenteral antimicrobial therapy. J Antimicrob Chemother. 2004; 53: ii83–ii86.
 
10. Larioza J, Girard A, Brown RB. Clinical experience with daptomycin for outpatient parenteral antibiotic therapy. Am J Med Sci. 2011; 342: 486–488.
 
11. Lipsky BA, Berendt AR, Cornia PB, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012; 54: e132–e173.
 
12. Peters EJ, Lipsky BA, Berendt AR, et al. A systematic review of the effectiveness of interventions in the management of infection in the diabetic foot. Diabetes Metab Res Rev. 2012; 28: 142–162.
 
13. Tice AD, Hoaglund PA, Shoultz DA. Outcomes of osteomyelitis among patients treated with outpatient parenteral antimicrobial therapy. Am J Med. 2003; 114: 723–728.
 
14. Chary A, Tice AD, Martinelli LP, et al. Experience of infectious diseases consultants with outpatient parenteral antimicrobial therapy: results of an emerging infections network survey. Clin Infect Dis. 2006; 43: 1290–1295.
 
15. Tice AD, Hoaglund PA, Nolet B, et al. Cost perspectives for outpatient intravenous antimicrobial therapy. Pharmacotherapy. 2002; 22: 63S–70S.

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