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Stoorvogel HH, van Egmond M, Wertheim HFL, Schouten JA, Hulscher MEJL, Peeters L, Kiers Y, Koenders S, Sprong T, van Mens SP, Tromp M, Richel O, Akkermans R, Ten Oever J. Occurrence and predictors of laboratory abnormalities during outpatient parenteral antimicrobial therapy - A multicenter cohort study to inform laboratory test monitoring. J Infect 2024; 89:106301. [PMID: 39357569 DOI: 10.1016/j.jinf.2024.106301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Accepted: 09/24/2024] [Indexed: 10/04/2024]
Abstract
OBJECTIVES Evidence on the optimal frequency of laboratory testing during outpatient parenteral antimicrobial therapy (OPAT) is lacking. Therefore, we investigated how often and when laboratory abnormalities occur during OPAT and which factors are associated with these abnormalities. METHODS We performed a multicenter cohort study in four Dutch hospitals among adult patients receiving OPAT and collected routinely obtained laboratory test results. Incidence and incidence rates were calculated for various laboratory abnormalities. Survival analysis was performed to visualize the time to the first occurrence of laboratory abnormalities and Poisson regression analysis to compare the number of abnormalities in the first and second 30 OPAT days among patients receiving OPAT for ≥60 days. Predictors were identified using a multivariable Cox proportional hazard regression model. RESULTS 45.1% of 1152 included patients developed laboratory abnormalities, but only 2% led to OPAT discontinuation. Hepatotoxicity was most common (33.9 events/1000 OPAT days), with a time-dependent decrease in the occurrence of the first hepatotoxic event, while hypokalemia was rare (1.7 events/1000 OPAT days). In the subgroup of patients receiving ≥60 days of OPAT, nephrotoxicity was more common in days 31-60. We observed partly toxicity-specific associations between antibiotic type, concomitant medication, baseline laboratory values, patient characteristics, and the occurrence of laboratory abnormalities. CONCLUSIONS While laboratory abnormalities are frequently observed during OPAT, they rarely lead to discontinuation of OPAT. Specific patient, treatment and laboratory characteristics were associated with the occurrence of laboratory abnormalities. Based on our results, we recommend a more personalized laboratory monitoring policy with less blood sampling.
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Affiliation(s)
- Hester H Stoorvogel
- Radboud University Medical Center, Department of Internal Medicine, Nijmegen, the Netherlands; Radboud University Medical Center, IQ Health Science Department, Nijmegen, the Netherlands; Radboud University Medical Center, Radboudumc Community for Infectious Diseases (RCI), Nijmegen, the Netherlands.
| | - Maartje van Egmond
- Radboud University Medical Center, Department of Internal Medicine, Nijmegen, the Netherlands; Radboud University Medical Center, Radboudumc Community for Infectious Diseases (RCI), Nijmegen, the Netherlands
| | - Heiman F L Wertheim
- Radboud University Medical Center, Radboudumc Community for Infectious Diseases (RCI), Nijmegen, the Netherlands; Radboud University Medical Center, Department of Medical Microbiology, Nijmegen, the Netherlands
| | - Jeroen A Schouten
- Radboud University Medical Center, IQ Health Science Department, Nijmegen, the Netherlands; Radboud University Medical Center, Radboudumc Community for Infectious Diseases (RCI), Nijmegen, the Netherlands; Radboud University Medical Center, Department of Intensive Care Medicine, Nijmegen, the Netherlands
| | - Marlies E J L Hulscher
- Radboud University Medical Center, IQ Health Science Department, Nijmegen, the Netherlands; Radboud University Medical Center, Radboudumc Community for Infectious Diseases (RCI), Nijmegen, the Netherlands
| | - Lars Peeters
- Radboud University Medical Center, Department of Internal Medicine, Nijmegen, the Netherlands; Radboud University Medical Center, Radboudumc Community for Infectious Diseases (RCI), Nijmegen, the Netherlands
| | - Yvonne Kiers
- Rijnstate, Department of Internal Medicine, Arnhem, the Netherlands
| | - Sofie Koenders
- Canisius Wilhelmina Hospital, Department of Internal Medicine, Nijmegen, the Netherlands
| | - Tom Sprong
- Canisius Wilhelmina Hospital, Department of Internal Medicine, Nijmegen, the Netherlands
| | - Suzan P van Mens
- Maastricht University Medical Center+, Department of Medical Microbiology, Infectious Diseases & Infection Prevention, Maastricht, the Netherlands
| | - Mirjam Tromp
- Radboud University Medical Center, Department of Internal Medicine, Nijmegen, the Netherlands; Radboud University Medical Center, Radboudumc Community for Infectious Diseases (RCI), Nijmegen, the Netherlands
| | - Olivier Richel
- Radboud University Medical Center, Department of Internal Medicine, Nijmegen, the Netherlands; Radboud University Medical Center, Radboudumc Community for Infectious Diseases (RCI), Nijmegen, the Netherlands
| | - Reinier Akkermans
- Radboud University Medical Center, IQ Health Science Department, Nijmegen, the Netherlands
| | - Jaap Ten Oever
- Radboud University Medical Center, Department of Internal Medicine, Nijmegen, the Netherlands; Radboud University Medical Center, Radboudumc Community for Infectious Diseases (RCI), Nijmegen, the Netherlands
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Metsä-Simola N, Saarenketo J, Lehtonen H, Broman N, Häggblom T, Björklöf P, Sariola S, Valta MP. Guidelines to practice in hospitals at home: safe and effective continuous infusion pumps substantially increased penicillin use in erysipelas treatment. Eur J Public Health 2024; 34:860-865. [PMID: 38996407 PMCID: PMC11430903 DOI: 10.1093/eurpub/ckae112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024] Open
Abstract
Hospitals at home are increasingly offering outpatient parenteral antimicrobial therapy (OPAT) in an attempt to reduce costly inpatient care, but these settings favour broad-spectrum antibiotics that require less frequent dosing than penicillin. Benzyl penicillin could be delivered via continuous infusion pumps (eCIPs), but studies on their safety and efficacy in OPAT are scarce, and it remains unclear how much the availability of eCIPs increases penicillin use in real-life settings. We examined 462 electronic healthcare records of erysipelas patients treated between January 2018 and January 2022 in a large Finnish OPAT clinic. Average marginal effects from logistic models were estimated to assess how the introduction of eCIPs in December 2020 affected penicillin use and to compare clinical outcomes between patients with and without eCIPs. Introduction of eCIPs increased the predicted probability of penicillin treatment by 36.0 percentage points (95% confidence interval 25.5-46.5). During eCIP implementation, patients who received an eCIP had 73.1 (58.0-88.2) percentage points higher probability than patients without an eCIP to receive penicillin treatment. They also had about 20 percentage points higher probability to be cured at the time of discharge and 3 months after it. Patient and nurse satisfaction regarding eCIPs was very high. Benzyl penicillin eCIP treatment is effective and safe, and substantially increases the use of penicillin instead of broad-spectrum antibiotics. To reduce the risk of antimicrobial resistance, eCIPs could increasingly be promoted for use in OPAT clinics, and there should be adequate education and support in their implementation.
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Affiliation(s)
- Niina Metsä-Simola
- Helsinki Institute for Demography and Population Health, University of Helsinki, Helsinki, Finland
- Max Planck, University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
| | - Jenni Saarenketo
- Turku City Hospital OPAT Clinic, The Wellbeing Services County of Southwest Finland, Turku, Finland
| | - Henri Lehtonen
- Turku City Hospital OPAT Clinic, The Wellbeing Services County of Southwest Finland, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - Niklas Broman
- Turku City Hospital OPAT Clinic, The Wellbeing Services County of Southwest Finland, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - Tony Häggblom
- Turku City Hospital Department of Infectious Diseases, The Wellbeing Services County of Southwest Finland, Turku, Finland
| | - Pia Björklöf
- Turku City Hospital OPAT Clinic, The Wellbeing Services County of Southwest Finland, Turku, Finland
| | - Salla Sariola
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Maija P Valta
- Turku City Hospital OPAT Clinic, The Wellbeing Services County of Southwest Finland, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
- Department of Hematology and Stem Cell Transplantation, Turku University Hospital, The Wellbeing Services County of Southwest Finland, Turku, Finland
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Burch AR, Ledergerber B, Ringer M, Padrutt M, Reiber C, Mayer F, Zinkernagel AS, Eberhard N, Kaelin MB, Hasse B. Improving antimicrobial treatment in terms of antimicrobial stewardship and health costs by an OPAT service. Infection 2024; 52:1367-1376. [PMID: 38421503 PMCID: PMC11289230 DOI: 10.1007/s15010-024-02194-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Outpatient parenteral antimicrobial therapy (OPAT) is a standard for antimicrobial therapy internationally. With this prospective cohort study, we aimed to assess the impact of an OPAT service as part of antimicrobial stewardship (AMS) and evaluate the safety and efficiency of the program while illuminating the financial benefit for the hospital. METHODS Socio-demographic data, treatment regimen and outcomes were prospectively recorded for all patients assigned to the program of the OPAT unit of the University Hospital of Zurich between November 2018 and September 2022. RESULTS In total, we recorded 303 OPAT assignments of which 260 resulted in effective OPAT episodes. The 260 OPAT episodes were further optimized toward the choice of antimicrobial agent (n = 18) and length of therapy (n = 6). Moreover, OPAT resulted in alteration of patient assessment and care led by AMS strategies in 247 of 260 episodes (95%). While the bed days saved per year increased consistently with time, a total of 3934 in-hospital treatment days were saved amounting to a cost saving of 9,835,000 CHF over 47 months. Adverse events were recorded in 46 cases whilst only two of these have been the reason for readmission during OPAT treatment. Clinical cure was noted in 77% (199/260) and was negatively associated with Charlson Comorbidity Index (CCI; OR per 1 unit higher 0.85 (95% CI 0.78-0.93)). CONCLUSION This study demonstrates the impact of an OPAT service in the framework of AMS as well as its benefits for the hospital whilst preserving safety and efficacy for the patient's parenteral antimicrobial treatment.
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Affiliation(s)
- Andrea R Burch
- University of Basel, Basel, Switzerland.
- Cantonal Pharmacy, University Hospital of Zurich, Spöndlistrasse 9, 8006, Zurich, Switzerland.
| | - Bruno Ledergerber
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Ringer
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Maria Padrutt
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Claudine Reiber
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Fabienne Mayer
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Annelies S Zinkernagel
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nadia Eberhard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Marisa B Kaelin
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Barbara Hasse
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Bouzigard R, Arnold M, Msibi SS, Player JK, Mang N, Hall B, Su J, Lane MA, Perl TM, Castellino LM. Outpatient Parenteral Antimicrobial Therapy in a Safety Net Hospital: Opportunities for Improvement. Open Forum Infect Dis 2024; 11:ofae190. [PMID: 38778862 PMCID: PMC11109603 DOI: 10.1093/ofid/ofae190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/02/2024] [Indexed: 05/25/2024] Open
Abstract
Background Outpatient parenteral antimicrobial therapy (OPAT) is a safe and cost-effective transitional care approach administered via different delivery models. No standards exist for appropriate OPAT program staffing. We examined outcomes of patients receiving OPAT via different care models to identify strategies to improve safety while reducing health care overuse. Methods Retrospective demographic, clinical, and outcome data of patients discharged with OPAT were reviewed in 2 periods (April-June 2021 and January-March 2022; ie, when staffing changed) and stratified by care model: self-administered OPAT, health care OPAT, and skilled nursing facility OPAT. Results Of 342 patients, 186 (54%) received OPAT in 2021 and 156 (46%) in 2022. Hospital length of stay rose from 12.4 days to 14.3 in 2022. In a Cox proportional hazards regression model, visits to the emergency department (ED) within 30 days of OPAT initiation (hazard ratio, 1.76; 95% CI, 1.13-2.73; P = .01) and readmissions (hazard ratio, 2.34; 95% CI, 1.22-4.49; P = .01) increased in 2022 vs 2021, corresponding to decreases in OPAT team staffing. Higher readmissions in the 2022 cohort were for reasons unrelated to OPAT (P = .01) while readmissions related to OPAT did not increase (P = .08). Conclusions In a well-established OPAT program, greater health care utilization-length of stay, ED visits, and readmissions-were seen during periods of higher staff turnover and attrition. Rather than blunt metrics such as ED visits and readmissions, which are influenced by multiple factors besides OPAT, our findings suggest the need to develop OPAT-specific outcome measures as a quality assessment tool and to establish optimal OPAT program staffing ratios.
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Affiliation(s)
- Rory Bouzigard
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Parkland Health, Dallas, Texas, USA
| | - Mark Arnold
- University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Sithembiso S Msibi
- Peter O’Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jacob K Player
- University of Texas Southwestern Medical School, Dallas, Texas, USA
| | | | | | - Joseph Su
- Peter O’Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael A Lane
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Parkland Health, Dallas, Texas, USA
| | - Trish M Perl
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Parkland Health, Dallas, Texas, USA
- Peter O’Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Laila M Castellino
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Parkland Health, Dallas, Texas, USA
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Cimino C, Rivera CG, Pearson JC, Colton B, Slain D, Mahoney MV. Pharmacotherapeutic Considerations in the Treatment of Nontuberculous Mycobacterial Infections: A Primer for Clinicians. Open Forum Infect Dis 2024; 11:ofae128. [PMID: 38560605 PMCID: PMC10977864 DOI: 10.1093/ofid/ofae128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Nontuberculous mycobacteria (NTM) can cause a variety of infections, including serious pulmonary disease. Treatment encompasses polypharmacy, with a targeted regimen of 2-5 active medications, depending on site of infection, species, and clinical characteristics. Medications may include oral, intravenous, and inhalational routes. Medication acquisition can be challenging for numerous reasons, including investigational status, limited distribution models, and insurance prior authorization. Additionally, monitoring and managing adverse reactions and drug interactions is a unique skill set. While NTM is primarily medically managed, clinicians may not be familiar with the intricacies of medication selection, procurement, and monitoring. This review offers insights into the pharmacotherapeutic considerations of this highly complex disease state, including regimen design, medication acquisition, safety monitoring, relevant drug-drug interactions, and adverse drug reactions.
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Affiliation(s)
- Christo Cimino
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Jeffrey C Pearson
- Department of Pharmacy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Benjamin Colton
- Pharmacy Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Douglas Slain
- Department of Clinical Pharmacy, School of Pharmacy and Section of Infectious Diseases, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Monica V Mahoney
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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6
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Fläring U, Lundevall H, Norberg Å, Andersson A. The success rate and complications of midline catheters in pediatric outpatient parenteral antibiotic therapy (OPAT). Eur J Pediatr 2024; 183:1703-1709. [PMID: 38227054 PMCID: PMC11001649 DOI: 10.1007/s00431-024-05432-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/17/2024]
Abstract
The use of outpatient parenteral antimicrobial therapy (OPAT) for children has several advantages, including reduced length of hospital stay and costs. A reliable vascular access is key to delivering safe and effective pediatric OPAT. In recent years, midline catheters (MC) have been increasingly used for short-term intravenous antibiotic therapy in children. However, there are no studies investigating the use of MCs in the OPAT setting. The main aim of this paper was to evaluate the success and complications of using MCs for pediatric OPAT. This was a retrospective cohort study from a tertiary academic pediatric hospital. All MCs inserted at the hospital and used for OPAT were eligible for study inclusion. The primary objective was to describe the percentage of patients able to complete OPAT without the need for additional venous access. Forty-one MCs were included in the study. Patient mean (SD) age was 5.9 (4.9) years. In 31 cases (76%, 95% CI 62-86%), the iv therapy could be successfully completed using only the MC. Imbalances between the groups suggested unfavorable outcome for saphenous vein catheters as well as for shorter and smaller-sized catheters. Fourteen patients (34%) were subjected to a MC-related complication. Pain on injection in the MC was the most frequent complication (n = 10, 24%). Conclusion: Midline catheters could be an alternative to central venous access for pediatric OPAT. Avoiding saphenous vein insertion and using longer and larger-sized catheters could increase MC success rate. No severe MC-related complication was found. Further randomized studies comparing different catheter types are needed. What is Known: • For selected patients, pediatric outpatient parenteral antimicrobial therapy (OPAT) is safe and provides health-economic, psychosocial, and medical advantages compared to in-hospital care. • A reliable venous access is one of the key factors to the success of OPAT, but this can be a challenge in children. What is New: • Using midline catheters, 76% of patients could complete their intended iv therapy without the need for additional venous access. Avoiding saphenous vein insertion and using longer and larger-sized catheters could increase the success rate. • Thirty-four percent of catheters were subject to some kind of complication, the most common being pain on injection in the catheter.
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Affiliation(s)
- Urban Fläring
- Department of Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Lundevall
- Department of Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Åke Norberg
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Andersson
- Department of Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
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7
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Nguyen N, Chua HC, Drake T, Jo J, Stramel SA, Vuong NN, Gonzales-Luna AJ, Olson K, On Behalf Of The Houston Infectious Diseases Network. Significant Publications on Infectious Diseases Pharmacotherapy in 2021. J Pharm Pract 2024; 37:198-211. [PMID: 36122416 DOI: 10.1177/08971900221128334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To summarize the most noteworthy infectious diseases (ID) pharmacotherapy articles published in peer-reviewed literature in 2021. Summary: Members of the Houston Infectious Diseases Network (HIDN) nominated articles that were deemed to have significant contributions to ID pharmacotherapy in 2021. These nominations included articles pertaining to both general ID, including coronavirus disease 2019 (COVID-19), and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pharmacotherapy. A total of 35 articles were nominated by HIDN: 30 articles pertaining to general ID pharmacotherapy and 5 articles with HIV/AIDS focus. To select the most influential articles of 2021, a survey was created and distributed to members of the Society of Infectious Diseases Pharmacists (SIDP). Of the 239 SIDP members who responded to the survey, there were 192 recorded votes for the top 10 general ID pharmacotherapy articles and 47 recorded votes for the top HIV/AIDS article, respectively. The top publications are summarized. Conclusion: Antimicrobial stewardship and the optimal management of infectious disease states continues to be a priority in the midst of the ongoing coronavirus disease 2019 (COVID-19) global pandemic. In light of the sheer volume of ID-related articles published in the past year, this review aims to aid clinicians in remaining up-to-date on key practice-changing ID pharmacotherapy publications from 2021.
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Affiliation(s)
- Nhi Nguyen
- Department of Pharmacy, The University of Texas Medical Branch, Galveston, TX, USA
| | - Hubert C Chua
- Department of Pharmacy, CHI Baylor St Luke's Medical Center, Houston, TX, USA
| | - Ty Drake
- Department of Pharmacy, Houston Methodist Willowbrook Hospital, Houston, TX, USA
| | - Jinhee Jo
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA
| | - Stefanie Anne Stramel
- Department of Pharmacy, Memorial Hermann Memorial City Medical Center, Houston, TX, USA
| | - Nancy N Vuong
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anne J Gonzales-Luna
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA
| | - Kelsey Olson
- Department of Pharmacy, HCA Houston Healthcare Clear Lake, Webster, TX, USA
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Canterino J, Malinis M, Liu J, Kashyap N, Brandt C, Justice A. Creation and Validation of an Automated Registry for Outpatient Parenteral Antibiotics. Open Forum Infect Dis 2024; 11:ofae004. [PMID: 38412514 PMCID: PMC10866572 DOI: 10.1093/ofid/ofae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/08/2024] [Indexed: 02/29/2024] Open
Abstract
Existing outpatient parenteral antibiotic therapy (OPAT) registries are resource intensive, and OPAT programs struggle to produce objective data to show the value of their work. We describe the building and validation of an automated OPAT registry within our electronic medical record and provide objective data on the value of the program. Variables and outcomes include age, sex, race, ethnicity, primary insurance payor, antibiotic names, infection syndromes treated, discharge disposition, 30-day all-cause readmission and death rates, complications, and an estimate of the hospital days saved. Records for 146 OPAT episodes were reviewed manually to validate the registry. Data were displayed in a dashboard within the electronic medical record. Over the 4-year time frame, our registry collected 3956 unique patients who completed 4710 episodes (approximately 1200 episodes per year). A total of 400 complications during OPAT were identified. All variables had an accuracy of >90% on validation. The OPAT program resulted in a reduction in hospital length of stay by 88 820 days, or roughly 22 000 days per year. We intend our registry to serve as a blueprint for similar OPAT programs with limited administrative resources. Wider application of our system would allow for easier aggregation and comparisons of OPAT practice and address the lack interinstitutional standardization of OPAT data and outcomes.
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Affiliation(s)
| | - Maricar Malinis
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jing Liu
- Yale–New Haven Health, New Haven, Connecticut, USA
| | - Nitu Kashyap
- Yale University School of Medicine, New Haven, Connecticut, USA
- Yale–New Haven Health, New Haven, Connecticut, USA
| | - Cynthia Brandt
- Veterans Affairs Heathcare System, West Haven CT; Yale University School of Medicine, New Haven, Connecticut, USA
| | - Amy Justice
- Veterans Affairs Heathcare System, West Haven CT; Yale University School of Medicine, New Haven, Connecticut, USA
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9
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Schellong P, Wennek-Klose J, Spiegel C, Rödel J, Hagel S. Successful outpatient parenteral antibiotic therapy with cefiderocol for osteomyelitis caused by multi-drug resistant Gram-negative bacteria: a case report. JAC Antimicrob Resist 2024; 6:dlae015. [PMID: 38328266 PMCID: PMC10848891 DOI: 10.1093/jacamr/dlae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/15/2024] [Indexed: 02/09/2024] Open
Abstract
Objectives Post-traumatic osteomyelitis attributed to metallo-β-lactamase (MBL)-producing Gram-negative bacteria presents a challenging clinical scenario. Cefiderocol emerges as a viable treatment option within the limited therapeutic options available. Patient/case description In this brief report, we present a case of a Ukrainian patient with osteomyelitis caused by multi-drug resistant Pseudomonas aeruginosa, which was successfully treated with cefiderocol, facilitated in part by outpatient parenteral antibiotic therapy (OPAT). Results and discussion Administration of Cefiderocol via OPAT can present a safe and effective option for treatment of post-traumatic osteomyelitis with multi-drug resistant Pseudomonas aeruginosa. A possible effect on iron homeostasis of extended treatment duration with cefiderocol may be taken into consideration.
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Affiliation(s)
- Paul Schellong
- Institute for Infectious Diseases and Infection Control, Jena University Hospital—Friedrich Schiller University Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Janett Wennek-Klose
- Hospital Care, Medipolis Intensive Care & Service GmbH Pharmaceutical OPAT Service Provider, Jena, Germany
| | - Christian Spiegel
- Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital—Friedrich Schiller University Jena, Jena, Germany
| | - Jürgen Rödel
- Institute of Medical Microbiology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Stefan Hagel
- Institute for Infectious Diseases and Infection Control, Jena University Hospital—Friedrich Schiller University Jena, Am Klinikum 1, 07747 Jena, Germany
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10
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Dumkow LE, Geyer AC, Davidson LE. Antimicrobial Stewardship at Transitions of Care. Infect Dis Clin North Am 2023; 37:769-791. [PMID: 37580244 DOI: 10.1016/j.idc.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
Antimicrobial stewardship interventions have historically been siloed in different care settings; recently, a need for stewardship interventions at care transitions has arisen as inappropriate prescribing at care transitions may result in patient harm. There are several care areas that should be considered for optimizing antibiotic prescribing. Interventions can be difficult to implement as they often require the efforts of a multidisciplinary team and are resource intensive. Antimicrobial stewardship programs should prioritize interventions at transitions of care to improve prescribing and patient outcomes.
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Affiliation(s)
- Lisa E Dumkow
- Trinity Health Grand Rapids, 200 Jefferson Avenue, Grand Rapids, MI 49503, USA.
| | - Abigail C Geyer
- Trinity Health Grand Rapids, 200 Jefferson Avenue, Grand Rapids, MI 49503, USA
| | - Lisa E Davidson
- Atrium Health, 1540 Garden Terrace, Suite 211, Charlotte, NC 28203, USA; Wake Forest School of Medicine, 475 Vine Street, Winston-Salem, NC 27101, USA
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Sunagawa SW, Arduser S, Miller MM, Lyden E, LeMaster M, Cortes-Penfield N, Hankins RJ, Bergman SJ, Alexander BT. Serious Adverse Events and Laboratory Monitoring Regimens for Outpatient Parenteral Antimicrobial Therapy With Cefazolin and Ceftriaxone. Open Forum Infect Dis 2023; 10:ofad606. [PMID: 38111751 PMCID: PMC10727193 DOI: 10.1093/ofid/ofad606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/29/2023] [Indexed: 12/20/2023] Open
Abstract
The optimal laboratory monitoring frequency for outpatient parenteral antimicrobial therapy-related adverse events (OPAT-AEs) during cefazolin and ceftriaxone therapy is not well defined. We identified 2.7 OPAT-AEs per 1000 sets of weekly laboratory tests in this population, suggesting that less intensive laboratory monitoring may be safe and reasonable.
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Affiliation(s)
- Shawnalyn W Sunagawa
- Department of Pharmaceutical and Nutrition Care, Nebraska Medicine, Omaha, Nebraska, USA
- College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sarah Arduser
- Department of Pharmaceutical and Nutrition Care, Nebraska Medicine, Omaha, Nebraska, USA
- College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Molly M Miller
- Department of Pharmaceutical and Nutrition Care, Nebraska Medicine, Omaha, Nebraska, USA
| | - Elizabeth Lyden
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Melissa LeMaster
- Department of Pharmaceutical and Nutrition Care, Nebraska Medicine, Omaha, Nebraska, USA
| | | | - Richard J Hankins
- Divison of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Scott J Bergman
- Department of Pharmaceutical and Nutrition Care, Nebraska Medicine, Omaha, Nebraska, USA
- College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Bryan T Alexander
- Department of Pharmaceutical and Nutrition Care, Nebraska Medicine, Omaha, Nebraska, USA
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12
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Yassin A, Huralska M, Pogue JM, Dixit D, Sawyer RG, Kaye KS. State of the Management of Infections Caused by Multidrug-Resistant Gram-Negative Organisms. Clin Infect Dis 2023; 77:e46-e56. [PMID: 37738671 DOI: 10.1093/cid/ciad499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Indexed: 09/24/2023] Open
Abstract
In the past decade, the prevalence of multidrug-resistant gram-negative (MDR-GN) bacterial infections has increased significantly, leading to higher rates of morbidity and mortality. Treating these infections poses numerous challenges, particularly when selecting appropriate empiric therapy for critically ill patients for whom the margin for error is low. Fortunately, the availability of new therapies has improved the treatment landscape, offering safer and more effective options. However, there remains a need to establish and implement optimal clinical and therapeutic approaches for managing these infections. Here, we review strategies for identifying patients at risk for MDR-GN infections, propose a framework for the choice of empiric and definitive treatment, and explore effective multidisciplinary approaches to managing patients in the hospital while ensuring a safe transition to outpatient settings.
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Affiliation(s)
- Arsheena Yassin
- Department of Pharmacy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Mariya Huralska
- Division of Allergy, Immunology and Infectious Diseases, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jason M Pogue
- Department of Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
- Department of Pharmacy, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Deepali Dixit
- Department of Pharmacy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
- Ernest Mario School of Pharmacy, Rutgers, State University of New Jersey, Piscataway, New Jersey, USA
| | - Robert G Sawyer
- Department of Surgery, Western Michigan University Homer Stryker School of Medicine, Kalamazoo, Michigan, USA
| | - Keith S Kaye
- Division of Allergy, Immunology and Infectious Diseases, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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13
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Joseph WS, Kosinski MA, Rogers LC. Parenteral Vancomycin in the Treatment of MRSA-Associated Diabetic Foot Infections: An Unnecessary Risk. INT J LOW EXTR WOUND 2023:15347346231207553. [PMID: 37886812 DOI: 10.1177/15347346231207553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Diabetic foot infections (DFIs) are a common and costly complication of diabetes. Soft tissue and bone infections in DFIs frequently lead to amputation and/or sepsis which can be costly for both the patient and the healthcare system. Staphylococcus aureus is the most commonly identified causative agent in DFIs, and people with diabetes may have an increased risk of infection with methicillin-resistant Staphylococcus aureus (MRSA). In addition to increased susceptibility to severe infection, MRSA in DFIs is associated with high rates of treatment failure, morbidity, and hospitalization costs meaning appropriate treatment is a high priority. While hospitalized patients are usually treated with intravenous (IV) vancomycin, this can be costly in terms of inpatient stays, staffing costs, and adverse events. For example, vancomycin-associated acute kidney injury not only delays hospital discharge and increases costs but is also a particular concern for patients with diabetes who already have an increased risk of kidney problems. Vancomycin-resistant strains of S. aureus have also been identified, which means that alternative treatment options may need to be explored. Treatment alternatives to IV vancomycin, including oral antibiotics, have been shown to provide similar efficacy, with reduced costs, outpatient or home-based administration, and with fewer serious adverse effects. Although infectious disease specialists often use IV vancomycin alone, or in combination, as a first-line therapeutic option, they are increasingly seeing the value of outpatient or at-home oral antibiotics as an alternative. This manuscript reviews the evidence for true costs of vancomycin therapy for MRSA-associated DFIs and examines the alternatives.
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Affiliation(s)
- Warren S Joseph
- Arizona College of Podiatric Medicine, Midwestern University, Glendale, AZ, USA
| | - Mark A Kosinski
- Department of Medicine, New York College of Podiatric Medicine, New York, NY, USA
| | - Lee C Rogers
- Department of Orthopaedics, University of Texas Health Science Center, San Antonio, TX, USA
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14
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Benefield RJ, McDonald J, Newman M, Tritle B, Certain LK. Patient safety outcomes for continuous infusion vancomycin as outpatient parenteral antimicrobial therapy. Pharmacotherapy 2023; 43:894-903. [PMID: 37248438 DOI: 10.1002/phar.2833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/09/2023] [Accepted: 04/10/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Administration of vancomycin as a continuous infusion has been associated with reduced nephrotoxicity. Given limited published experience with continuous infusion vancomycin in outpatient parenteral antimicrobial therapy (OPAT) programs, we reviewed outcomes from our center. METHODS This was a retrospective, single-center study of adult patients receiving vancomycin OPAT as continuous or intermittent infusion for an intended treatment duration of at least 7 days. The primary outcome was time to nephrotoxicity with continuous versus intermittent infusion vancomycin while on OPAT; additional outcomes included time to any vancomycin-associated adverse event, time to 60-day death or readmission, and time to 60-day emergency department encounter. Proportional hazards modeling was used to identify variables independently associated with outcomes, as well as assess the strength of association of continuous infusion with each outcome. RESULTS Four-hundred ninety-two patients were included: 118 treated with continuous and 374 with intermittent vancomycin infusion. Continuous infusion was not associated with lower rates of nephrotoxicity compared to intermittent infusion (adjusted hazard ratio (aHR) 0.72, 95% CI: 0.35-1.50). There were no advantages of continuous over intermittent infusion in the rates of any adverse event (aHR 0.93, 95% CI: 0.56-1.53), 60-day death or readmission (aHR 1.04, 95% CI: 0.68-1.61), or 60-day emergency department encounter (aHR 1.17, 95% CI: 0.68-1.99). Vancomycin area under the concentration-time curve (AUC) at discharge was the only modifiable factor identified that was independently associated with patient safety outcomes. CONCLUSION There was no appreciable benefit of continuous infusion vancomycin on outpatient safety outcomes. AUC-centered dosing approaches warrant further investigation as strategies to improve vancomycin safety in OPAT programs.
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Affiliation(s)
- Russell J Benefield
- Department of Pharmacy, University of Utah Health, Salt Lake City, Utah, USA
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
| | - Joshua McDonald
- Department of Pharmacy, University of Utah Health, Salt Lake City, Utah, USA
| | - Michael Newman
- Data Sciences Services, University of Utah Health, Salt Lake City, Utah, USA
| | - Brandon Tritle
- Department of Pharmacy, University of Utah Health, Salt Lake City, Utah, USA
| | - Laura K Certain
- Division of Infectious Diseases, University of Utah Health, Salt Lake City, Utah, USA
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15
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Rodríguez-Martínez L, Castro-Balado A, Hermelo-Vidal G, Bandín-Vilar E, Varela-Rey I, Toja-Camba FJ, Rodríguez-Jato T, Novo-Veleiro I, Varela-García PM, Zarra-Ferro I, González-Barcia M, Mondelo-García C, Mateos J, Fernández-Ferreiro A. Ampicillin Stability in a Portable Elastomeric Infusion Pump: A Step Forward in Outpatient Parenteral Antimicrobial Therapy. Pharmaceutics 2023; 15:2099. [PMID: 37631313 PMCID: PMC10458095 DOI: 10.3390/pharmaceutics15082099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) with continuous infusion pumps is postulated as a very promising solution to treat complicated infections, such as endocarditis or osteomyelitis, that require patients to stay in hospital during extended periods of time, thus reducing their quality of life and increasing the risk of complications. However, stability studies of drugs in elastomeric devices are scarce, which limits their use in OPAT. Therefore, we evaluated the stability of ampicillin in sodium chloride 0.9% at two different concentrations, 50 and 15 mg/mL, in an elastomeric infusion pump when stored in the refrigerator and subsequently in real-life conditions at two different temperatures, 25 and 32 °C, with and without the use of a cooling device. The 15 mg/mL ampicillin is stable for up to 72 h under refrigeration, allowing subsequent dosing at 25 °C for 24 h with and without a cooling device, but at 32 °C its concentration drops below 90% after 8 h. In contrast, 50 mg/mL ampicillin only remains stable for the first 24 h under refrigeration, and subsequent administration at room temperature is not possible, even with the use of a cooling system. Our data support that 15 mg/mL AMP is suitable for use in OPAT if the volume and rate of infusion are tailored to the dosage needs of antimicrobial treatments.
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Affiliation(s)
- Lorena Rodríguez-Martínez
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (L.R.-M.); (A.C.-B.); (A.F.-F.)
| | - Ana Castro-Balado
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (L.R.-M.); (A.C.-B.); (A.F.-F.)
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
- Pharmacology, Pharmacy and Pharmaceutical Technology Department, Faculty of Pharmacy, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain
| | - Gonzalo Hermelo-Vidal
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (L.R.-M.); (A.C.-B.); (A.F.-F.)
| | - Enrique Bandín-Vilar
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (L.R.-M.); (A.C.-B.); (A.F.-F.)
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
- Pharmacology, Pharmacy and Pharmaceutical Technology Department, Faculty of Pharmacy, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain
| | - Iria Varela-Rey
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (L.R.-M.); (A.C.-B.); (A.F.-F.)
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
- Pharmacology, Pharmacy and Pharmaceutical Technology Department, Faculty of Pharmacy, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain
| | - Francisco José Toja-Camba
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (L.R.-M.); (A.C.-B.); (A.F.-F.)
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
- Pharmacology, Pharmacy and Pharmaceutical Technology Department, Faculty of Pharmacy, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain
| | - Teresa Rodríguez-Jato
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (L.R.-M.); (A.C.-B.); (A.F.-F.)
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Ignacio Novo-Veleiro
- Home Hospitalization Unit, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Pablo Manuel Varela-García
- Internal Medicine Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Irene Zarra-Ferro
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (L.R.-M.); (A.C.-B.); (A.F.-F.)
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Miguel González-Barcia
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (L.R.-M.); (A.C.-B.); (A.F.-F.)
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Cristina Mondelo-García
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (L.R.-M.); (A.C.-B.); (A.F.-F.)
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Jesús Mateos
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (L.R.-M.); (A.C.-B.); (A.F.-F.)
| | - Anxo Fernández-Ferreiro
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (L.R.-M.); (A.C.-B.); (A.F.-F.)
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
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16
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Solomon DA, Beieler AM, Levy S, Eaton EF, Sikka MK, Thornton A, Dhanireddy S. Perspectives on the Use of Outpatient Parenteral Antibiotic Therapy for People who Inject Drugs: Results From an Online Survey of Infectious Diseases Clinicians. Open Forum Infect Dis 2023; 10:ofad372. [PMID: 37520410 PMCID: PMC10372854 DOI: 10.1093/ofid/ofad372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Indexed: 08/01/2023] Open
Abstract
Injection-related infections require prolonged antibiotic therapy. Outpatient parenteral antimicrobial therapy (OPAT) has been shown to be feasible for people who inject drugs (PWID) in some settings. We report a national survey on practice patterns and attitudes of infectious diseases clinicians in the United States regarding use of OPAT for PWID.
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Affiliation(s)
- Daniel A Solomon
- Correspondence: Daniel A. Solomon, MD, 75 Francis St, Boston, MA 02115 ()
| | | | - Sera Levy
- University of Alabama, Birmingham, Alabama, USA
| | | | - Monica K Sikka
- Oregon Health & Sciences University, Portland, Oregon, USA
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17
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A Multidisciplinary Approach to Outpatient Parenteral Antimicrobial Therapy Care. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2023. [DOI: 10.1097/ipc.0000000000001254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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18
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Lueking R, Wei W, Mang NS, Ortwine JK, Meisner J. Evaluation of Dalbavancin Use on Clinical Outcomes, Cost-Savings, and Adherence at a Large Safety Net Hospital. Microbiol Spectr 2023; 11:e0238522. [PMID: 36537818 PMCID: PMC9927367 DOI: 10.1128/spectrum.02385-22] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/18/2022] [Indexed: 02/16/2023] Open
Abstract
Dalbavancin is a second-generation lipoglycopeptide antibiotic with activity against Gram-positive organisms. Dalbavancin is Food and Drug Administration (FDA)-approved for acute bacterial skin and soft tissue infections (ABSSTIs). There is a lack of substantial data on dalbavancin in more invasive infections, particularly in high-risk populations (patients with intravenous drug use and unstable living conditions). In this retrospective observational study, we reviewed all patients that received at least one dose of dalbavancin in an inpatient or outpatient setting at Parkland Hospital from February of 2019 to August of 2021. The demographics, type of infection, and rationale for dalbavancin were collected at the baseline. Clinical failure was measured by an avoidance of emergency department (ED) visits or hospital readmission at 30, 60, and 90 days. A separate analysis was conducted to estimate hospital, rehabilitation, or nursing facility days saved based on the projected length of treatment. 40 patients were included, and the majority were uninsured (85%), experiencing homelessness (60%), or had intravenous drug use (IDU) (57.5%). Indications for use included ABSSTIs (45%), bloodstream infection (67.5%), osteomyelitis (40%), infective endocarditis (10%), and septic arthritis (10%). Clinical failure was observed in 5 of the 40 patients (12.5%). Nonadherence to medical recommendations, a lack of source control, and ongoing IDU increased the risk of failure. Dalbavancin saved a total of 566 days of inpatient, rehabilitation, and nursing facility stays. Dalbavancin is a reasonable alternative to the standard of care in an at-risk population, offering decreased lengths of stays and cost savings. The uses of second-generation lipoglycopeptides are desirable alternatives to traditional outpatient parenteral antibiotic therapies for patients who otherwise would not qualify or for patients who desire less hospital contact in light of the COVID-19 pandemic. IMPORTANCE This study contributes additional experience to the literature of dalbavancin use in off-label indications, particularly for patients who do not qualify for outpatient parenteral antimicrobial therapy. The majority of the patient population were people who inject drugs and the uninsured. There is difficulty in tracking outcomes in this patient population, given their outpatient follow-up rates; however, we were able to track emergency room visits and readmissions throughout the majority of the local metroplex. The clinical use of dalbavancin at our institution also increased in the midst of the COVID-19 pandemic in an effort to preserve hospital resources and limit health care exposure. In addition, we are able to provide institution-specific cost-saving data with the use of dalbavancin.
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Affiliation(s)
- Richard Lueking
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Wenjing Wei
- Department of Pharmacy Services, Parkland Health, Dallas, Texas, USA
| | - Norman S. Mang
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Jessica K. Ortwine
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Jessica Meisner
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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19
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Bhagat H, Sikka MK, Sukerman ES, Makadia J, Lewis JS, Streifel AC. Evaluation of Opportunities for Oral Antibiotic Therapy in Bone and Joint Infections. Ann Pharmacother 2023; 57:156-162. [PMID: 35656850 DOI: 10.1177/10600280221101105] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The OVIVA trial suggests oral antibiotics are an alternative to intravenous antibiotics to treat bone and joint infections (BJI). A shift in practice to treatment with oral antibiotics would eliminate the need for central vascular access, improve patient satisfaction, and reduce overall healthcare costs. OBJECTIVE The primary objective was to identify the proportion of patients treated for BJIs with outpatient parenteral antimicrobial therapy (OPAT) who would have qualified for oral antibiotics based on microbiological data. The secondary objective was to conduct a cost-analysis to estimate potential cost-savings had eligible patients been treated with oral antibiotics. METHODS This was a single-center, retrospective study of adult patients in the United States treated with intravenous antibiotics for BJIs from January 2018 to April 2020. Inclusion and exclusion criteria matched the OVIVA trial. Patients with Staphylococcus aureus bacteremia, endocarditis, or other high-risk features were excluded. RESULTS 281 patients met the inclusion criteria. Most had prosthetic joint infections (56%). Infections caused by coagulase-negative staphylococci (25%) were most common, followed by S. aureus (23%) and polymicrobial infections (22%). 69 (25%) patients required a switch during their OPAT course to an alternate antibiotic agent. Thirteen patients (5%) experienced vascular access complications, and 6 patients (2%) developed Clostridiodes difficile infections. Oral therapy could have resulted in an estimated average savings per patient of $3,270.69 USD. CONCLUSION AND RELEVANCE Most patients treated with OPAT for BJIs were candidates for oral antibiotics. A change in practice would result in cost-savings to the U.S. healthcare system.
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Affiliation(s)
- Hita Bhagat
- Department of Pharmacy, Oregon Health & Science University, Portland, OR, USA
| | - Monica K Sikka
- School of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, USA
| | - Ellie S Sukerman
- School of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, USA
| | - Jina Makadia
- School of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, USA
| | - James S Lewis
- Department of Pharmacy, Oregon Health & Science University, Portland, OR, USA.,School of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, USA
| | - Amber C Streifel
- Department of Pharmacy, Oregon Health & Science University, Portland, OR, USA
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20
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Williams B, Muklewicz J, Steuber TD, Williams A, Edwards J. Comparison of Inpatient Standard-of-Care to Outpatient Oritavancin Therapy for Patients With Acute Uncomplicated Cellulitis. J Pharm Pract 2023; 36:27-32. [PMID: 34080450 DOI: 10.1177/08971900211021258] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Shifting inpatient antibiotic treatment to outpatient parenteral antimicrobial therapy may minimize treatment for acute bacterial skin and skin structure infections, including cellulitis. The purpose of this evaluation was to compare 30-day hospital readmission or admission due to cellulitis and economic outcomes of inpatient standard-of-care (SoC) management of acute uncomplicated cellulitis to outpatient oritavancin therapy. METHODS This retrospective, observational cohort study was conducted at a 941-bed community teaching hospital. Adult patients 18 years and older treated for acute uncomplicated cellulitis between February 2015 to December 2018 were eligible for inclusion. Information was obtained from hospital and billing department records. Patients were assigned to either inpatient SoC or outpatient oritavancin cohorts for comparison. RESULTS 1,549 patients were included in the study (1,348 in the inpatient SoC cohort and 201 in the outpatient oritavancin cohort). The average length of stay for patients admitted was 3.6 ± 1.5 days. The primary outcome of 30-day hospital readmission or admission due to cellulitis occurred in 49/1348 (3.6%) patients in the inpatient SoC cohort versus 1/201 (0.5%) in the outpatient oritavancin cohort (p = 0.02). The difference between costs and reimbursement was improved in the outpatient oritavancin group (p < 0.001). CONCLUSION Outpatient oritavancin for acute uncomplicated cellulitis was associated with reduction in 30-day hospital readmissions or admissions compared to inpatient SoC. Beneficial economic outcomes for the outpatient oritavancin cohort were observed. Additional studies are required to confirm these findings.
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Affiliation(s)
- Brandy Williams
- Department of Pharmacy, 532836Huntsville Hospital, Huntsville, AL, USA
| | - Justin Muklewicz
- Department of Pharmacy, 532836Huntsville Hospital, Huntsville, AL, USA
| | - Taylor D Steuber
- Department of Pharmacy, 532836Huntsville Hospital, Huntsville, AL, USA.,Department of Pharmacy Practice, 15460Auburn University Harrison School of Pharmacy, Huntsville, AL, USA
| | - April Williams
- Department of Pharmacy, 532836Huntsville Hospital, Huntsville, AL, USA
| | - Jonathan Edwards
- Department of Pharmacy, 532836Huntsville Hospital, Huntsville, AL, USA
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21
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Van Abel AL, Childs-Kean LM, Jensen KL, Mynatt RP, Ryan KL, Rivera CG. A review of evidence, antimicrobial stability, and feasibility considerations for OPAT continuous infusion. Ther Adv Infect Dis 2023; 10:20499361231191877. [PMID: 37636216 PMCID: PMC10451047 DOI: 10.1177/20499361231191877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/18/2023] [Indexed: 08/29/2023] Open
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) has been widely used in clinical practice for many decades because of its associated cost savings, reductions in inpatient hospital days, and decreases in hospital-associated infections. Despite this long history, evolving practice patterns and new drug delivery devices continue to present challenges as well as opportunities for clinicians when designing appropriate outpatient antimicrobial regimens. One such change is the increasing use of extended and continuous infusion (CI) of antimicrobials to optimize the achievement of pharmacokinetic and pharmacodynamic targets. Elastomeric devices are also becoming increasingly popular in OPAT, including for the delivery of CI. In this article, we review the clinical evidence for CI in OPAT, as well as practical considerations of patient preferences, cost, and antimicrobial stability.
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Affiliation(s)
- Amy L. Van Abel
- Department of Pharmacy, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | | | - Kelsey L. Jensen
- Mayo Clinic Health System – Southeast Minnesota Region, Austin, MN, USA
| | | | - Keenan L. Ryan
- Department of Pharmacy, University of New Mexico, Albuquerque, NM, USA
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22
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Johnson TM, Whitman Webster LC, Mehta M, Johnson JE, Cortés-Penfield N, Rivera CG. Pushing the agenda for intravenous push administration in outpatient parenteral antimicrobial therapy. Ther Adv Infect Dis 2023; 10:20499361231193920. [PMID: 37600976 PMCID: PMC10434178 DOI: 10.1177/20499361231193920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023] Open
Abstract
Intravenous push (IVP) antimicrobial administration refers to rapid bolus infusion of medication. This drug delivery method offers improved patient convenience, superior patient and nursing satisfaction, and cost savings when used in outpatient parenteral antimicrobial therapy (OPAT). Antimicrobial agents must demonstrate optimal physiochemical and pharmacologic characteristics, as well as sufficient syringe stability, to be administered in this manner. Additionally, impacts on medication tolerability, patient safety, and effectiveness must be considered. This narrative review summarizes the available data and practical implications of IVP administration of antimicrobials in the OPAT setting.
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Affiliation(s)
- Tanner M. Johnson
- Department of Pharmacy, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | | | - Meera Mehta
- West Virginia University Hospitals, Morgantown, WV, USA
| | - Jessica E. Johnson
- Department of Medicine, Section of Infectious Diseases, West Virginia University, Morgantown, WV, USA
| | | | - Christina G. Rivera
- Department of Pharmacy, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Dolly LM, Rivera CG, Jensen KL, Mara KC, Schreier DJ, Virk A, Arensman Hannan KN. Comparative renal risk of long-term use of beta-lactams in combination with vancomycin across the continuum of care. Ther Adv Infect Dis 2023; 10:20499361231189589. [PMID: 37576023 PMCID: PMC10422906 DOI: 10.1177/20499361231189589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/06/2023] [Indexed: 08/15/2023] Open
Abstract
Background Data are controversial regarding nephrotoxicity risk with vancomycin plus piperacillin-tazobactam (VPT) compared to vancomycin alone or in combination with other beta-lactams (BLs) in acute care use. Furthermore, data are lacking on the incidence of acute kidney injury (AKI) with long-term use of VPT including outpatient parenteral antimicrobial therapy (OPAT). Methods This retrospective study included 826 adult patients on an intravenous vancomycin plus BL for ⩾2 weeks, including cefepime, piperacillin/tazobactam, ertapenem, or meropenem, from August 2017 to January 2022. The primary outcome was incidence of AKI. Univariate and multivariable Cox proportional hazard regression analyses were conducted to adjust for confounding variables. A secondary analysis based on the propensity score (PS)-matched cohort was performed. Results AKI occurred in 14.4% of patients in the VPT group (n = 15/104) compared to 5.5% in the other BL group (n = 40/722) (p < 0.001). Average time to AKI from start of combination therapy was 9.4 (1.7-12.0) days in the VPT group and 10.9 (5-22.7) days in the other BL group (p = 0.20). The median duration of vancomycin and BL in the overall cohort was approximately 1 month. Beyond BL selection, patient characteristics were not associated with AKI other than the receipt of concomitant acyclovir [hazard ratio (HR) 2.48 (95% confidence interval (CI): 1.33-4.65), p = 0.004]. In the PS-matched cohort, AKI occurred in 14.4% of patients in the VPT group (n = 15/104) and 5.3% in the other BL group (n = 11/208) (p = 0.006). Receipt of VPT [HR: 2.55 (1.36-4.78), p = 0.004] and acyclovir [HR: 2.38 (1.19-4.74), p = 0.014) remained significantly associated with AKI in the multivariable model. Conclusion Clinicians should exercise caution when using VPT for >2 weeks, including in the OPAT setting, even when no renal dysfunction is observed during the initial week of combination therapy.
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Affiliation(s)
- Lauren M. Dolly
- Department of Pharmacy, U.S. Department of Veterans Affairs, 2501 W 22nd Street, Sioux Falls, SD 57105, US
| | | | - Kelsey L. Jensen
- Department of Pharmacy, Mayo Clinic Health System, Austin, MN, USA
| | - Kristin C. Mara
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Abinash Virk
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
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Larnard J, Swords K, Taupin D, Padival S. From sea to shining IV: the current state of OPAT in the United States. Ther Adv Infect Dis 2023; 10:20499361231181486. [PMID: 37363442 PMCID: PMC10285263 DOI: 10.1177/20499361231181486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
First described in the United States, outpatient parenteral antibiotic therapy (OPAT) has become an indispensable part of treating serious infections. The proportion of infectious disease (ID) physicians utilizing a formal OPAT program has increased in recent years, but remains a minority. In addition, many ID physicians have indicated that OPAT programs have inadequate financial and administrative support. Given the medical complexity of patients receiving OPAT, as well as the challenges of communicating with OPAT providers across health care facilities and systems, OPAT programs ideally should involve a multidisciplinary team. The majority of patients in the United States receive OPAT either at home with assistance from home infusion companies and visiting nurses or at a skilled nursing facility (SNF), though the latter has been associated with lower rates of patient satisfaction. Current and future opportunities and challenges for OPAT programs include providing OPAT services for people who inject drugs (PWID) and incorporating the increasing use of oral antibiotics for infections historically treated with parenteral therapy. In this review, we will discuss the current practice patterns and patient experiences with OPAT in the United States, as well as identify future challenges and opportunities for OPAT programs.
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Affiliation(s)
| | - Kyleen Swords
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Dan Taupin
- Division of Infectious Diseases, Jefferson Health, Philadelphia, PA, USA
| | - Simi Padival
- Division of Infectious Diseases, University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA
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Hassanzai M, Adanç F, Koch B, Verkaik N, van Oldenrijk J, de Bruin J, de Winter B, van Onzenoort H. Best practices, implementation and challenges of outpatient parenteral antimicrobial therapy: results of a worldwide survey among healthcare providers. Ther Adv Infect Dis 2023; 10:20499361231214901. [PMID: 38127471 PMCID: PMC10722947 DOI: 10.1177/20499361231214901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/01/2023] [Indexed: 12/23/2023] Open
Abstract
Background Outpatient Parenteral Antimicrobial Therapy (OPAT) is considered a patient-friendly and cost-effective practice. Patients in the OPAT service can be at risk for developing adverse events. Due to extensive variations in practice, guidelines have been developed to minimize the risks. Objectives In this first worldwide survey on OPAT, we explored the current OPAT services around the world, adherence to recommendations and identified best practices and challenges from different perspectives. Methods An e-survey was conducted and consisted of questions about demographics, characteristics of the OPAT service, role of pharmacy, future developments, and respondents' views on improvements as well as best practices. Results A total of 126 responses from 28 countries were included. Seventy-eight percent (78%) of the respondents stated that their facility provides antimicrobial therapy in the outpatient setting, whereas 22% did not. Forty-two percent (42%) of the hospitals with OPAT services had a specialized OPAT service, while 14% lacked specialized services and 22% had a partially specialized team in place. In facilities with a specialized OPAT service, the number of mandatory infectious disease (ID) consultations before discharge and clinical monitoring by an ID specialist or OPAT team member, the frequency of monitoring, and the availability of an OPAT registry were higher. A multidisciplinary team's presence was commonly noted as best practices. On the other hand, respondents experienced difficulties with reimbursement and lack of standardization in the screening, follow-up and monitoring of patients. Conclusion This survey provides a better understanding of the implementation and practices of OPAT services globally and describes best practices and the challenges from different professionals.
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Affiliation(s)
- Moska Hassanzai
- Department of Hospital Pharmacy, Erasmus MC University Medical Center, Postal box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Fadime Adanç
- Department of Hospital Pharmacy, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Birgit Koch
- Department of Hospital Pharmacy, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- CATOR: Center for Antimicrobial Treatment Optimization Rotterdam, The Netherlands
| | - Nelianne Verkaik
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jakob van Oldenrijk
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jorg de Bruin
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Brenda de Winter
- Department of Hospital Pharmacy, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- CATOR: Center for Antimicrobial Treatment Optimization Rotterdam, The Netherlands
| | - Hein van Onzenoort
- Department of Pharmacy, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, The Netherlands
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Bradley AC, Wingler MJB, Artman KL, Ward LM, Lucar J. An evaluation of risk factors for readmission in patients receiving outpatient parenteral antimicrobial therapy. Ther Adv Infect Dis 2023; 10:20499361231195966. [PMID: 37667754 PMCID: PMC10475225 DOI: 10.1177/20499361231195966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023] Open
Abstract
Background Outpatient parenteral antimicrobial therapy (OPAT), when required, is beneficial to patients and healthcare systems by reducing hospital length-of-stay, providing cost savings, and improving patient satisfaction. Objectives The purpose of this study is to determine readmission rates and associated risk factors in patients receiving OPAT at home. Methods This retrospective study included hospitalized patients 15 years and older who were discharged on intravenous antimicrobial therapy via OPAT at home between January 2018 and December 2019. Patients receiving antimicrobials at a skilled nursing facility, long-term acute care, or dialysis center, and those who began OPAT at home directly from the outpatient setting were excluded. The primary outcome of this study was all-cause 30-day readmission rate. Secondary outcomes included 90-day readmission rate, rates of complications related to OPAT, emergency department visits during OPAT, and predictors of all-cause 30-day readmission through a logistic regression analysis. Results Two hundred individual patients were included in the analysis; 60% were male and the mean age was 49 years. The most common indications for OPAT at home were bone and joint infection (52%) and bacteremia (26%). Forty patients (20%) experienced an unplanned, all-cause 30-day readmission, with a total of 48 readmission events. Of the 40 patients who were readmitted within 30 days, 20 (50%) were due to non-OPAT related reasons. Sixty patients (30%) experienced an OPAT-related complication, and chronic kidney disease was found to be an independent predictor of readmission (OR: 2.8, 95% CI: 1.0-7.6). Conclusions Patients receiving OPAT at home are at increased risk for early hospital readmission, but it is often due to reasons not associated with OPAT. Patients with chronic kidney disease beginning OPAT at home should be closely monitored after discharge.
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Affiliation(s)
- Abby C. Bradley
- Department of Pharmacy, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Pharmacy, Ascension St. Vincent’s East, Birmingham, AL, USA
| | - Mary Joyce B. Wingler
- Department of Antimicrobial Stewardship, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS 39216-4505, USA
| | - Katherine L. Artman
- Department of Pharmacy, University of Mississippi Medical Center, Jackson, MS, USA
| | - Lori M. Ward
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jose Lucar
- Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
- Division of Infectious Diseases, Department of Medicine, The George Washington University, Washington, DC, USA
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Billmeyer KN, Ross JK, Hirsch EB, Evans MD, Kline SE, Galdys AL. Predictors of adverse safety events and unscheduled care among an outpatient parenteral antimicrobial therapy (OPAT) patient cohort. Ther Adv Infect Dis 2023; 10:20499361231179668. [PMID: 37332294 PMCID: PMC10272639 DOI: 10.1177/20499361231179668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Background Select circumstances require outpatient parenteral antimicrobial therapy (OPAT). The potency of OPAT agents presents an increased risk of adverse events and unscheduled medical care. We analyzed these outcomes among OPAT recipients as part of the implementation of a collaborative OPAT program. Methods Adult patients discharged home from an academic hospital with OPAT between January 2019 and June 2021 were included in this retrospective cohort; participants discharged between June 2020 and June 2021 were part of the collaborative OPAT program. Patients with cystic fibrosis were excluded. Data on patient characteristics and outcomes were collected from electronic medical records by two reviewers. Multivariable analysis was conducted to identify predictors of vascular access device (VAD) complications, adverse drug events (ADEs), and OPAT-related emergency department (ED) visits and rehospitalizations. Results Among 265 patients included in the cohort, 57 (21.5%) patients experienced a VAD complication; obesity [odds ratio (OR): 3.32; 95% confidence interval (CI): 1.38-8.73; p = 0.01) and multi-drug therapy (OR: 2.56; 95% CI: 1.21-5.39; p = 0.01) were associated with an increased odds of VAD complication. Eighty-two (30.9%) participants experienced an ADE; 30 (11.3%) experienced a severe/serious ADE. Lipo/glycopeptide receipt, (OR: 5.28; 95% CI: 1.89-15.43; p < 0.01) and Black/African American race (OR: 4.85; 95% (CI): 1.56-15.45; p < 0.01) were associated with an increased odds of severe/serious ADE. Inclusion in the OPAT collaborative was associated with a decreased odds of severe/serious ADE (OR: 0.26; 95% CI: 0.08-0.77; p = 0.01). Fifty-eight (21.9%) patients experienced an OPAT-related ED visit and 53 (20.0%) experienced an OPAT-related rehospitalization. VAD complication (OR: 2.37; 95% (CI): 1.15-4.86, p = 0.02) and ADEs (OR: 2.19; CI: 1.13-4.22; p = 0.02) were associated with OPAT-related ED visits. ADE was associated with 90-day OPAT-related rehospitalization (OR: 3.21; (CI): 1.59-6.58; p < 0.01). Conclusion Adverse safety events and OPAT-related unscheduled care occurred often in our cohort. A structured OPAT program that includes ID pharmacist antibiotic reconciliation may reduce rates of ADEs.
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Affiliation(s)
| | - Jennifer K. Ross
- M Health Fairview University of Minnesota Medical Center, Minneapolis, MN, USA
| | | | - Michael D. Evans
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Susan E. Kline
- M Health Fairview University of Minnesota Medical Center, Minneapolis, MN, USA
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Alison L. Galdys
- Division of Infectious Diseases and International Medicine, Department of Medicine, Medical School, University of Minnesota, 420 Delaware Street SE, Mayo Mail Code 250, Minneapolis, MN 55455, USA
- M Health Fairview University of Minnesota Medical Center, Minneapolis, MN, USA
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Mehta M, Benning M, Johnson JE, Ryan KL. Facilitating OPAT in rural areas. Ther Adv Infect Dis 2023; 10:20499361231210353. [PMID: 37954405 PMCID: PMC10634261 DOI: 10.1177/20499361231210353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
A sizable portion of the United States' population lives in a rural setting. Coupled with a limited number of infectious diseases providers, this has created a need for innovative practice models to deliver outpatient antimicrobial therapy and clinical monitoring in rural settings. This article reviews existing literature regarding outpatient parenteral antimicrobial therapy in rural settings and explores existing barriers and potential solutions that may be of assistance to providers looking to provide these services.
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Affiliation(s)
- Meera Mehta
- West Virginia University Hospitals, Morgantown, WV, USA
| | - Molly Benning
- Inpatient Pharmacy Department, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Jessica E. Johnson
- Department of Medicine, Section of Infectious Diseases, West Virginia University, Morgantown, WV, USA
| | - Keenan L. Ryan
- Inpatient Pharmacy Department, University of New Mexico Hospital, 2211 Lomas Blvd, Albuquerque, NM 87106, USA
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Oliveira PR, Carvalho VC, Uip DE, Lima ALLM. Outpatient parenteral antimicrobial therapy in Brazil. Ther Adv Infect Dis 2023; 10:20499361231178625. [PMID: 37304574 PMCID: PMC10251471 DOI: 10.1177/20499361231178625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
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Tan KK, Hino G, Zhou AY, Al-Fayiz H, Rodriguez S, Abdul-Mutakabbir JC. Identifying the potential impact of a multidisciplinary outpatient antimicrobial therapy program in an area of high social vulnerability. Ther Adv Infect Dis 2023; 10:20499361231194257. [PMID: 37636217 PMCID: PMC10460041 DOI: 10.1177/20499361231194257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Background Outpatient parenteral antimicrobial therapy (OPAT) and complex outpatient antimicrobial therapy (COpAT) are common practice in the management of infectious diseases (IDs). However, providing OPAT/COpAT can pose significant challenges pre- and post-discharge, particularly in vulnerable patient populations. Objectives The objective of this study is to assess outpatient complications related to OPAT/COpAT in patients discharged with a home health services referral and to identify pre- and post-discharge intervention opportunities and the associated cost-savings that could be achieved with a multidisciplinary ID team-run OPAT/COpAT program. Design/methods This is a retrospective cohort study of patients who were discharged with OPAT/COpAT through home health services over a 3-month study period. Data on potential pre-discharge interventions and post-discharge complications were recorded. Results Medication-related issues were the most common pre-discharge complications, accounting for more than 50% of identified intervention opportunities. More than half of the included patients experienced at least one documented outpatient complication post-discharge with peripherally inserted central catheter-line-related complication (20.7%) being the most common issue. Using previously published cost-estimates, the implementation of a designated pre- and post-discharge OPAT/COpAT program could have saved over $100,000 over the 3-month study period. Conclusion A multidisciplinary OPAT/COpAT program located in a high social vulnerable area can help reduce complications related to a patient's antimicrobial therapy. Medication-related issues represent a major area for potential intervention. Our findings suggest that a multidisciplinary ID team will have ample opportunities to improve the transition of care, at both pre- and post-discharge, for patients requiring antimicrobial therapy.
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Affiliation(s)
- Karen K. Tan
- Department of Pharmacy, Loma Linda University Medical Center, 24745 Stewart Street, Loma Linda, CA 92354, USA
- Loma Linda University School of Pharmacy, Loma Linda, CA, USA
| | - Garret Hino
- Department of Pharmacy, Loma Linda University Medical Center, Loma Linda, CA, USA
- Loma Linda University School of Pharmacy, Loma Linda, CA, USA
| | - Anna Y. Zhou
- Department of Pharmacy, Loma Linda University Medical Center, Loma Linda, CA, USA
- Loma Linda University School of Pharmacy, Loma Linda, CA, USA
| | - Hadeel Al-Fayiz
- Loma Linda University School of Pharmacy, Loma Linda, CA, USA
| | - Sasha Rodriguez
- Loma Linda University School of Pharmacy, Loma Linda, CA, USA
| | - Jacinda C. Abdul-Mutakabbir
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
- Division of the Black Diaspora and African American Studies, University of California San Diego, La Jolla, CA, USA
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Jhaveri VV, Sullivan C, Ward A, Giurini JM, Karchmer AW, Stillman IE, Davis RB, Freed JA, LaSalvia MT, Stead W. More Specialties, Fewer Problems: Using Collaborative Competency Between Infectious Diseases, Podiatry, and Pathology to Improve the Care of Patients with Diabetic Foot Osteomyelitis. J Am Podiatr Med Assoc 2022; 112:461851. [PMID: 33630067 DOI: 10.7547/20-178] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/16/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Diabetic foot osteomyelitis is a common infection where treatment involves multiple services, including infectious diseases, podiatry, and pathology. Despite its ubiquity in the hospital, consensus on much of its management is lacking. METHODS Representatives from infectious diseases, podiatry, and pathology interested in quality improvement developed multidisciplinary institutional recommendations culminating in an educational intervention describing optimal diagnostic and therapeutic approaches to diabetic foot osteomyelitis (DFO). Knowledge acquisition was assessed by preintervention and postintervention surveys. Inpatients with forefoot DFO were retrospectively reviewed before and after intervention to assess frequency of recommended diagnostic and therapeutic maneuvers, including appropriate definition of surgical bone margins, definitive histopathology reports, and unnecessary intravenous antibiotics or prolonged antibiotic courses. RESULTS A postintervention survey revealed significant improvements in knowledge of antibiotic treatment duration and the role of oral antibiotics in managing DFO. There were 104 consecutive patients in the preintervention cohort (April 1, 2018, to April 1, 2019) and 32 patients in the postintervention cohort (November 5, 2019, to March 1, 2020), the latter truncated by changes in hospital practice during the coronavirus disease 2019 pandemic. Noncategorizable or equivocal disease reports decreased from before intervention to after intervention (27.0% versus 3.3%, respectively; P = .006). We observed nonsignificant improvement in correct bone margin definition (74.0% versus 87.5%; P = .11), unnecessary peripherally inserted central catheter line placement (18.3% versus 9.4%; P = .23), and unnecessary prolonged antibiotics (21.9% versus 5.0%; P = .10). In addition, by working as an interdisciplinary group, many solvable misunderstandings were identified, and processes were adjusted to improve the quality of care provided to these patients. CONCLUSIONS This quality improvement initiative regarding management of DFO led to improved provider knowledge and collaborative competency between these three departments, improvements in definitive pathology reports, and nonsignificant improvement in several other clinical endpoints. Creating collaborative competency may be an effective local strategy to improve knowledge of diabetic foot infection and may generalize to other common multidisciplinary conditions.
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Affiliation(s)
- Vimal V Jhaveri
- *Division of Infectious Diseases, Department of Medicine, Boston, MA.,¶Harvard Medical School, Boston, MA
| | - Christopher Sullivan
- †Division of Podiatry, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Ashley Ward
- ‡Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA.,¶Harvard Medical School, Boston, MA
| | - John M Giurini
- †Division of Podiatry, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Adolf W Karchmer
- *Division of Infectious Diseases, Department of Medicine, Boston, MA.,¶Harvard Medical School, Boston, MA
| | - Isaac E Stillman
- ‡Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA.,¶Harvard Medical School, Boston, MA
| | - Roger B Davis
- ‖Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.,¶Harvard Medical School, Boston, MA
| | - Jason A Freed
- §Division of Hematology and Hematologic Malignancies, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.,¶Harvard Medical School, Boston, MA
| | - Mary T LaSalvia
- *Division of Infectious Diseases, Department of Medicine, Boston, MA.,¶Harvard Medical School, Boston, MA.,#Co-senior author
| | - Wendy Stead
- *Division of Infectious Diseases, Department of Medicine, Boston, MA.,¶Harvard Medical School, Boston, MA.,#Co-senior author
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Staples JA, Ho M, Ferris D, Hayek J, Liu G, Tran KC, Sutherland JM. Outpatient Versus Inpatient Intravenous Antimicrobial Therapy: A Population-Based Observational Cohort Study of Adverse Events and Costs. Clin Infect Dis 2022; 75:1921-1929. [PMID: 35439822 DOI: 10.1093/cid/ciac298] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Bacterial infections such as osteomyelitis and endocarditis routinely require several weeks of treatment with intravenous (IV) antimicrobials. Outpatient parenteral antimicrobial therapy (OPAT) programs allow patients to receive IV antimicrobials in an outpatient clinic or at home. The outcomes and costs of such treatments remain uncertain. METHODS We conducted a retrospective observational cohort study over a 5-year study interval (1 June 2012 to 31 March 2018) using population-based linked administrative data from British Columbia, Canada. Patients receiving OPAT following a hospitalization for bacterial infection were matched based on infection type and implied duration of IV antimicrobials to patients receiving inpatient parenteral antimicrobial therapy (IPAT). Cumulative adverse events and direct healthcare costs were estimated over a 90-day outcome interval. RESULTS In a matched cohort of 1842 patients, adverse events occurred in 35.6% of OPAT patients and 39.0% of IPAT patients (adjusted odds ratio, 1.04 [95% confidence interval {CI}, .83-1.30; P = .61). Relative to IPAT patients, OPAT patients were significantly more likely to experience hospital readmission (30.5% vs 23.0%) but significantly less likely to experience Clostridioides difficile diarrhea (1.2% vs 3.1%) or death (2.0% vs 8.8%). Estimated mean direct healthcare costs were $30 166 for OPAT patients and $50 038 for IPAT patients (cost ratio, 0.60; average cost savings with OPAT, $17 579 [95% CI, $14 131-$21 027]; P < .001). CONCLUSIONS Outpatient IV antimicrobial therapy is associated with a similar overall prevalence of adverse events and with substantial cost savings relative to patients remaining in hospital to complete IV antimicrobials. These findings should inform efforts to expand OPAT use.
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Affiliation(s)
- John A Staples
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Clinical Epidemiology & Evaluation, Vancouver, Canada.,Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation & Outcome Sciences, Vancouver, Canada
| | - Meghan Ho
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Dwight Ferris
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Jan Hayek
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Guiping Liu
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Karen C Tran
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation & Outcome Sciences, Vancouver, Canada
| | - Jason M Sutherland
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation & Outcome Sciences, Vancouver, Canada
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Omadacycline for management of Mycobacterium abscessus infections: a review of its effectiveness, place in therapy, and considerations for use. BMC Infect Dis 2022; 22:874. [PMID: 36419143 PMCID: PMC9682665 DOI: 10.1186/s12879-022-07857-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022] Open
Abstract
The Mycobacterium abscessus complex (MABC) is a group of acid-fast, rapidly dividing non-tuberculous mycobacteria (NTM) that include a number of clinically important subspecies, including M. abscessus, M. bolletii, and M. massiliense. These organisms are prevalent in the environment and are primarily associated with human pulmonary or skin and skin structure infections (SSSI) but may cause more deep-seeded disseminated infections and bacteremia in the immunocompromised. Importantly, these NTM are resistant to most first-line anti-tuberculous agents and, due to intrinsic or acquired resistance, exhibit exceedingly low, variable, and geographically distinct susceptibilities to commonly used antibacterial agents including older tetracyclines, macrolides, aminoglycosides, cephalosporins, carbapenems, and sulfamethoxazole-trimethoprim. Omadacycline is a novel third-generation member of the tetracycline family of antibacterials that has recently been demonstrated to have potent anti-NTM effects and clinical efficacy against MABC, including M. abscessus. The purpose of this review is to present a comprehensive and up-to-date assessment on the body of literature on the role of omadacycline for M. abscessus infections. Specifically, the in vitro and in vivo microbiology, mechanisms of action, mechanisms of resistance, clinical pharmacokinetics, clinical efficacy, adverse effects, dosage and administration, and place in therapy of omadacycline in management of M. abscessus infections will be detailed.
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Ortonobes S, Mujal-Martínez A, de Castro Julve M, González-Sánchez A, Jiménez-Pérez R, Hernández-Ávila M, De Alfonso N, Maye-Pérez I, Valle-Delmás T, Rodríguez-Sánchez A, Pino-García J, Gómez-Valent M. Successful Integration of Clinical Pharmacists in an OPAT Program: A Real-Life Multidisciplinary Circuit. Antibiotics (Basel) 2022; 11:1124. [PMID: 36009993 PMCID: PMC9404975 DOI: 10.3390/antibiotics11081124] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/08/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) programs encompass a range of healthcare processes aiming to treat infections at home, with the preferential use of the intravenous route. Although several barriers arise during the implementation of OPAT circuits, recent cumulative data have supported the effectiveness of these programs, demonstrating their application in a safe and cost-effective manner. Given that OPAT is evolving towards treating patients with higher complexity, a multidisciplinary team including physicians, pharmacists, and nursing staff should lead the program. The professionals involved require previous experience in infectious diseases treatment as well as in outpatient healthcare and self-administration. As we describe here, clinical pharmacists exert a key role in OPAT multidisciplinary teams. Their intervention is essential to optimize antimicrobial prescriptions through their participation in stewardship programs as well as to closely follow patients from a pharmacotherapeutic perspective. Moreover, pharmacists provide specialized counseling on antimicrobial treatment technical compounding. In fact, OPAT elaboration in sterile environments and pharmacy department clean rooms increases OPAT stability and safety, enhancing the quality of the program. In summary, building multidisciplinary teams with the involvement of clinical pharmacists improves the management of home-treated infections, promoting a safe self-administration and increasing OPAT patients' quality of life.
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Affiliation(s)
- Sara Ortonobes
- Pharmacy Department, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Barcelona, Spain
- Parc Taulí Research and Innovation Institute Foundation (I3PT), 08028 Sabadell, Barcelona, Spain
| | - Abel Mujal-Martínez
- Parc Taulí Research and Innovation Institute Foundation (I3PT), 08028 Sabadell, Barcelona, Spain
- Hospital at Home Unit, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Barcelona, Spain
| | - María de Castro Julve
- Pharmacy Department, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Barcelona, Spain
- Parc Taulí Research and Innovation Institute Foundation (I3PT), 08028 Sabadell, Barcelona, Spain
| | - Alba González-Sánchez
- Hospital at Home Unit, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Barcelona, Spain
| | - Rafael Jiménez-Pérez
- Hospital at Home Unit, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Barcelona, Spain
| | - Manuel Hernández-Ávila
- Hospital at Home Unit, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Barcelona, Spain
| | - Natalia De Alfonso
- Hospital at Home Unit, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Barcelona, Spain
| | - Ingrid Maye-Pérez
- Hospital at Home Unit, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Barcelona, Spain
| | - Teresa Valle-Delmás
- Hospital at Home Unit, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Barcelona, Spain
| | - Alba Rodríguez-Sánchez
- Hospital at Home Unit, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Barcelona, Spain
| | - Jessica Pino-García
- Pharmacy Department, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Barcelona, Spain
| | - Mònica Gómez-Valent
- Pharmacy Department, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Barcelona, Spain
- Parc Taulí Research and Innovation Institute Foundation (I3PT), 08028 Sabadell, Barcelona, Spain
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Attwood LO, McKechnie M, Vujovic O, Higgs P, Lloyd‐Jones M, Doyle JS, Stewardson AJ. Review of management priorities for invasive infections in people who inject drugs: highlighting the need for patient-centred multidisciplinary care. Med J Aust 2022; 217:102-109. [PMID: 35754144 PMCID: PMC9539935 DOI: 10.5694/mja2.51623] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/18/2022] [Accepted: 05/30/2022] [Indexed: 09/26/2023]
Abstract
There has been a global increase in the burden of invasive infections in people who inject drugs (PWID). It is essential that patient-centred multidisciplinary care is provided in the management of these infections to engage PWID in care and deliver evidence-based management and preventive strategies. The multidisciplinary team should include infectious diseases, addictions medicine (inclusive of alcohol and other drug services), surgery, psychiatry, pain specialists, pharmacy, nursing staff, social work and peer support workers (where available) to help address the comorbid conditions that may have contributed to the patient's presentation. PWID have a range of antimicrobial delivery options that can be tailored in a patient-centred manner and thus are not limited to prolonged hospital admissions to receive intravenous antimicrobials for invasive infections. These options include discharge with outpatient parenteral antimicrobial therapy, long-acting lipoglycopeptides (dalbavancin and oritavancin) and early oral antimicrobials. Open and respectful discussion with PWID including around harm reduction strategies may decrease the risk of repeat presentations with injecting-related harms.
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Affiliation(s)
| | | | - Olga Vujovic
- Alfred HealthMelbourneVIC
- Monash UniversityMelbourneVIC
| | - Peter Higgs
- Burnet InstituteMelbourneVIC
- La Trobe UniversityMelbourneVIC
| | | | - Joseph S Doyle
- Alfred HealthMelbourneVIC
- Monash UniversityMelbourneVIC
- Burnet InstituteMelbourneVIC
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36
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Antimicrobial Stewardship for the Infusion Nurse. JOURNAL OF INFUSION NURSING 2022; 45:201-209. [PMID: 35820124 DOI: 10.1097/nan.0000000000000472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The consequences of antimicrobial overuse are complex. Censoring overuse requires strategic efforts directed at tailoring antimicrobial prescribing habits. Antimicrobial stewardship combats the negative consequences for patients and society. All members of the health care team can influence stewardship efforts in the patient treated for infectious diseases. Many of the potent antimicrobials used today are given by infusion, providing an exceptional opportunity for the infusion nurse to become a crucial part of the antimicrobial stewardship team. The goal of this article is to explain why antimicrobials are worth caring for and preserving, as well as to define the role of the infusion nurse in the antimicrobial stewardship team.
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37
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Cabrera López IM, Agúndez Reigosa B, Adrados García S, Villalobos Pinto E, Cano Fernández J, Jiménez García R. Home-hospital care for children with acute illnesses: A 2-year follow-up study. J Paediatr Child Health 2022; 58:969-977. [PMID: 34967977 DOI: 10.1111/jpc.15870] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/21/2021] [Accepted: 12/05/2021] [Indexed: 11/29/2022]
Abstract
AIM Procedures normally performed in the hospital setting are increasingly delivered as part of hospital at home (HAH) programmes. The aim of this study is to describe the procedures and diseases treated during the first 2 years of a new paediatric HAH programme. METHODS This is a retrospective, observational study conducted in the HAH programme of Niño Jesús Children's Hospital (Spain). We included demographic data, diagnosis and procedures delivered to patients admitted to the HAH programme from November 2018 to November 2020. RESULTS There were 935 admissions of 833 patients. The median age was 5 years (interquartile range 2.3-9.5). Seventy-five percent of patients were previously healthy. The most frequent illnesses were acute infections (37%) (e.g. complicated appendicitis and ENT, genitourinary, skin and soft tissue infections) and acute respiratory diseases (17.3%) (e.g. asthma, bronchiolitis and pneumonia). Thirty-six percent of admissions underwent nocturnal polysomnography. The median length of stay was 4 days (SD 4.9 days). Eight percent of the episodes studied required care in the emergency department due to condition worsening (55.3%) and problems with devices (36.1%). Hospital readmission was required in 5.6% of cases, 42.4% of which later resumed care in the HAH. The estimated daily cost of HAH is 330.65 euros, while the hospital per-day costs of polysomnography, asthma and endovenous therapy are 1899.24, 1402.5, and 976.26 euros. Ninety percent of families reported a high level of satisfaction. CONCLUSIONS Paediatric HAH programmes are a feasible, cost-effective alternative to hospital care. Further studies should compare the evolution of patients treated in the traditional hospital setting and those in HAH.
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Affiliation(s)
- Isabel M Cabrera López
- Pediatric Hospital at Home Department, Niño Jesús University Children´s Hospital, Menéndez Pelayo, Madrid, Spain
| | - Beatriz Agúndez Reigosa
- Pediatric Hospital at Home Department, Niño Jesús University Children´s Hospital, Menéndez Pelayo, Madrid, Spain
| | - Sandra Adrados García
- Pediatric Hospital at Home Department, Niño Jesús University Children´s Hospital, Menéndez Pelayo, Madrid, Spain
| | - Enrique Villalobos Pinto
- General Pediatrics Department, Niño Jesús University Children´s Hospital, Menéndez Pelayo, Madrid, Spain
| | - Julia Cano Fernández
- General Pediatrics Department, Niño Jesús University Children´s Hospital, Menéndez Pelayo, Madrid, Spain
| | - Raquel Jiménez García
- Pediatric Hospital at Home Department, Niño Jesús University Children´s Hospital, Menéndez Pelayo, Madrid, Spain.,General Pediatrics Department, Niño Jesús University Children´s Hospital, Menéndez Pelayo, Madrid, Spain
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Montalto M, Ko SQ. Telling the difference and the telling differences between hospital in the home and outpatient parenteral antibiotic therapy. Intern Med J 2022; 52:880-884. [PMID: 35538016 DOI: 10.1111/imj.15780] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 11/27/2022]
Abstract
Doctors, authors, funders and hospital managers should take care to distinguish the important differences between hospital in the home (HIH) and outpatient parenteral antimicrobial therapy (OPAT) services. HIH is an inpatient service delivered at home usually by (or on behalf of) hospitals, which aims to substitute for a traditional inpatient stay. It does so by delivering a wide range of hospital treatments to patients at home, or residential aged care, using hospital medical and nursing staff, delivery technologies and venous access, pharmacy, radiology and pathology, and a structured system of on call and governance. OPAT is an outpatient service, usually run through infectious diseases physicians' offices or departments. Most care is delivered in infusion centres and requires patients to travel for their care. Generally, there is no after-hours support. HIH has supplanted the role of OPAT due to improved governance and a wider clinical and severity scope. HIH is accessible from hospital emergency departments or directly from residential aged care facilities. Inpatient capacity has been expanded during the COVID-19 pandemic. There is evidence that both HIH and OPAT can successfully treat their selected patient groups. There are no head-to-head studies, but in observational comparisons there might be more adverse drug events in OPAT. OPAT places a greater onus of care, supervision and travel needs on the patient and family. Where HIH is not available, OPAT may remain an alternative for some patients. However, HIH seeks to redefine the delivery of inpatient care away from the location of care.
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Affiliation(s)
- Michael Montalto
- Hospital in the Home Unit, Epworth Health Care, Melbourne, Victoria, Australia
| | - Stephanie Q Ko
- Department of Medicine, National University Hospital, Singapore
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Esteban-Cartelle B, Vicente-Oliveros N, Menéndez-Conde CP, Serrano DR, Martín-Dávila P, Fortún-Abete J, León-Gil LA, Álvarez-Díaz A. Antibiotic stability in portable elastomeric infusion devices: A systematic review. Am J Health Syst Pharm 2022; 79:1355-1368. [PMID: 35511829 DOI: 10.1093/ajhp/zxac122] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE Although outpatient parenteral antibiotic therapy (OPAT) can be a good approach to treatment of infections, a lack of data regarding antibiotic stability in portable elastomeric infusion devices restricts its safe, appropriate, and effective use. The objective of this work was to complete a systematic peer-reviewed analysis of published articles about antibiotic stability in elastomeric infusion devices that provide evidence supporting their use in OPAT. SUMMARY A systematic review following PRISMA guidelines was conducted in January 2021 to identify published articles about antibiotic stability in portable elastomeric infusion devices. The databases used were PubMed, Embase, Web of Science, and a Cochrane database. A total of 1,615 original studies and conference communications were found. After title, abstract, and full-text review, 33 articles met the inclusion criteria. The data obtained included information about the stability of 30 different antibiotics. To our knowledge, this is the first review to summarize the available published data on the stability of antibiotics in portable elastomeric infusion devices. The results highlight the poor stability of some antibiotics in solution and the variability of the laboratory conditions in the included studies. CONCLUSION This systematic review can serve as a useful resource for healthcare professionals involved in providing OPAT using portable elastomeric infusion devices. However, further stability studies should be performed, especially high-quality studies simulating real-life time and temperature conditions.
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Affiliation(s)
- Beatriz Esteban-Cartelle
- Ramón y Cajal University Hospital, Madrid, Spain, and Department of Pharmaceutics and Food Technology, School of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | | | | | - Dolores R Serrano
- Department of Pharmaceutics and Food Technology, School of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | - Pilar Martín-Dávila
- Service of Infectious Diseases, Ramón y Cajal University Hospital, Madrid, Spain
| | - Jesús Fortún-Abete
- Service of Infectious Diseases, Ramón y Cajal University Hospital, Madrid, Spain
| | | | - Ana Álvarez-Díaz
- Pharmacy Department, Ramón y Cajal University Hospital, Madrid, Spain
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40
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Rivera CG, Mara KC, Mahoney MV, Ryan KL. Survey of pharmacists on their roles and perceptions of outpatient parenteral antimicrobial therapy in the United States. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e69. [PMID: 36483442 PMCID: PMC9726508 DOI: 10.1017/ash.2022.40] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/13/2022] [Accepted: 03/07/2022] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To define outpatient parenteral antimicrobial therapy (OPAT) clinical pharmacy practice across the United States, specifically pharmacist functions, design of pharmacist involvement, and to compare pharmacist training of those who practice in OPAT to infectious diseases pharmacists who do not. METHODS A survey of a possible 32 questions was emailed to the American College of Clinical Pharmacists (ACCP) Infectious Diseases Practice and Research Network (PRN) e-mail list. Results were focused on US-based respondents. PARTICIPANTS In total, 87 pharmacists responded; 27 of these pharmacists (31%) practiced in OPAT. RESULTS Training background did not differ between groups. Programs with an OPAT pharmacist were more likely to have a formal OPAT team compared to those without an OPAT pharmacist (P < .001). OPAT pharmacists were early in their careers with 66.7% practicing <5 years in OPAT. Most OPAT pharmacists (66.7%) practiced at an academic medical center with a median full-time equivalent (FTE) of 0.6. Moreover, 63% utilized a collaborative practice agreement and 81.5% shared job functions with other pharmacist roles, most commonly antimicrobial stewardship. Few OPAT programs involved a dispensing component (28%). The median daily census was 43 patients followed by an OPAT pharmacist. Pharmacists performed a variety of tasks in OPAT. CONCLUSION Pharmacist nondispensing involvement in OPAT is an emerging trend in the United States with wide variability in program structure and pharmacist tasks. A ratio of 1 OPAT pharmacist for every 45-70 OPAT patients is proposed to facilitate expansion of pharmacist clinical practice in OPAT.
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Affiliation(s)
| | - Kristin C. Mara
- Mayo Clinic Department of Quantitative Health Sciences, Rochester, Minnesota
| | | | - Keenan L. Ryan
- University of New Mexico Hospital, Albuquerque, New Mexico
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41
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Nephrotoxic medications and associated acute kidney injury in hospitalized neonates. J Nephrol 2022; 35:1679-1687. [PMID: 35167057 DOI: 10.1007/s40620-022-01264-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Hospitalized neonates are often treated with nephrotoxic medications, a known risk factor for acute kidney injury (AKI). Nephrotoxic medications and AKI, especially in periviable neonates, could be detrimental to nephrogenesis. Our objectives were to evaluate the prevalence of neonatal treatment with nephrotoxic medications and its relationship with AKI in in the first 28 days of life, and to delineate the associated demographics and diagnoses. STUDY DESIGN Multicenter retrospective analysis using the national Pediatric Hospital Information System database, including 49 pediatric hospitals. Neonates admitted within the first two postnatal days were included. Treatment with 37 nephrotoxic medications across demographics and clinical variables, and relationship with AKI were evaluated. AKI was determined by using the International Classification of Diseases codes. RESULTS Of 192,229 neonates, 74% were treated with at least one nephrotoxic medication. Incidence of AKI was significantly higher in the treated group (aRR 3.68 [95% CI: 2.85, 4.75]). The aRRs of treatment were increased in infants born < 32-week, and < 2000 g. Nephrotoxic medications were prescribed to 90-95% of neonates born ≤ 28-week gestational age. Most treatments (95-98%) occurred in the first 3 days. Intravascular aminoglycosides were the most frequent type; 28% of neonates were treated for ≥ 4 calendar days. Most common diagnoses were infections (25%) and patent ductus arteriosus (20%). CONCLUSIONS Neonatal treatment with nephrotoxic medications is common, especially among the smallest, most immature preterm neonates and demonstrates a need for initiatives to reduce neonatal exposure to these agents, when feasible. Across all gestational age categories, the prevalence of AKI is higher in the neonates treated with nephrotoxic drugs. The long-term effects of treatment with nephrotoxic medications and subsequent AKI on nephrogenesis and nephron endowment will need to be evaluated.
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Douiyeb S, de la Court JR, Tuinte B, Sombogaard F, Schade RP, Kuijvenhoven M, Minderhoud T, Sigaloff KCE. Risk factors for readmission among patients receiving outpatient parenteral antimicrobial therapy: a retrospective cohort study. Int J Clin Pharm 2022; 44:557-563. [PMID: 35157228 PMCID: PMC9007809 DOI: 10.1007/s11096-022-01379-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/20/2022] [Indexed: 11/29/2022]
Abstract
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. The aim of our retrospective study was to identify risk factors for readmission in patients discharged with OPAT. Patients who were at least 18 years or older, discharged with OPAT between January 2016-December 2018 were included. Variables that were 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. 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 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 associated with readmission. 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 patients with OPAT is more likely to increase the rate of monitoring to prevent readmissions and complications.
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Affiliation(s)
- Sabrine Douiyeb
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC - Location VUmc, Amsterdam, The Netherlands.
| | - Jara R de la Court
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC - Location VUmc, Amsterdam, The Netherlands.,Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Bram Tuinte
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC - Location VUmc, Amsterdam, The Netherlands
| | - Ferdi Sombogaard
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC - Location VUmc, Amsterdam, The Netherlands
| | - Rogier P Schade
- Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Marianne Kuijvenhoven
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC - Location VUmc, Amsterdam, The Netherlands
| | - Tanca Minderhoud
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC - Location VUmc, Amsterdam, The Netherlands
| | - Kim C E Sigaloff
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC - Location VUmc, Amsterdam, The Netherlands
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43
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Efficacy and safety of home-based intravenous antibiotic therapy among adults: a systematic review. Int J Antimicrob Agents 2022; 59:106555. [DOI: 10.1016/j.ijantimicag.2022.106555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/02/2022] [Accepted: 02/12/2022] [Indexed: 11/18/2022]
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Beardsley J, Patel S, Cook C, Pierce B, Johnson J, Ohl C, Luther V. Inpatient Antibiotic Costs Associated With Switching From Vancomycin to Daptomycin for Outpatient Parenteral Antibiotic Therapy. Hosp Pharm 2022; 57:17-19. [PMID: 35521017 PMCID: PMC9065530 DOI: 10.1177/0018578720970466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose: The common practice of changing patients to daptomycin for outpatient parenteral antibiotic therapy (OPAT) can increase inpatient daptomycin use and impact inpatient pharmacy expenses. The purpose of this study was to quantify the additional inpatient antibiotic expenditures associated with changing patients from vancomycin to daptomycin for OPAT. Methods: This study examined patients who were discharged from January 1, 2018 to June 30, 2019. Patients were included if they were ≥18 years old, transitioned from vancomycin to daptomycin prior to discharge, and were cared for by the Infectious Diseases OPAT program. Patients switched to daptomycin for therapeutic reasons were excluded. A cost analysis evaluating the vancomycin regimen prior to changing to daptomycin and the daptomycin doses given prior to discharge and during readmissions for the first 6 weeks after discharge was performed using Wholesale Acquisition Costs. The primary outcome was the inpatient antibiotic expense associated with changing to daptomycin for OPAT. Results: Sixty-eight patients met study criteria. The mean number of inpatient doses of daptomycin administered prior to discharge was 4.3. Twelve patients were readmitted and received a mean of 5.3 additional doses. The estimated cost difference between the inpatient daptomycin doses and equivalent vancomycin therapy was $2647 per patient. Limiting patients to only 1 pre-discharge dose of daptomycin would reduce this cost difference to $926 per patient. Conclusion: Switching from vancomycin to daptomycin for OPAT can be associated with substantial inpatient pharmacy costs. These excessive costs can be mitigated if only 1 dose of daptomycin is given before discharge.
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Affiliation(s)
- James Beardsley
- Wake Forest Baptist Health, Winston-Salem, NC, USA,Wake Forest School of Medicine, Winston-Salem, NC, USA,James Beardsley, Department of Pharmacy, Wake Forest Baptist Health, 1 Medical Center Drive, Winston-Salem, NC 27157, USA.
| | | | - Corbin Cook
- Wingate University School of Pharmacy, Wingate, NC, USA
| | - Brandi Pierce
- Wingate University School of Pharmacy, Wingate, NC, USA
| | - James Johnson
- Wake Forest Baptist Health, Winston-Salem, NC, USA,Wake Forest School of Medicine, Winston-Salem, NC, USA,James Beardsley, Department of Pharmacy, Wake Forest Baptist Health, 1 Medical Center Drive, Winston-Salem, NC 27157, USA.
| | | | - Vera Luther
- Wake Forest School of Medicine, Winston-Salem, NC, USA
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45
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Huggins CE, Park TE, Boateng E, Zeana C. The Impact of a Standardized Discharge Process on 30-Day Readmissions for Patients on Outpatient Parenteral Antibiotic Treatment. Hosp Pharm 2022; 57:107-111. [PMID: 35521026 PMCID: PMC9065516 DOI: 10.1177/0018578720985434] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Introduction: Outpatient parenteral antibiotic treatment (OPAT) is associated with shorter length of hospital stay and reduced cost. Yet, patients discharged home on OPAT are at risk of hospital readmissions due to adverse events and complications. Although the impact of a multidisciplinary approach to readmission has been assessed by previous studies, addition of an innovative technology has not been evaluated for OPAT. This study examines the impact of a multidisciplinary approach including automated voice calls on 30-day readmissions of OPAT patients. Methods: A post-discharge transitional care process (PDTCP) targeting OPAT patients was implemented in fall 2016. This process included an automated telephone patient engagement service and coordination among pharmacy, nursing, medicine, and social work personnel. The patients on OPAT received automated telephone calls at 2, 9, 16, 28, and 40 days post-discharge to ensure medication availability and adherence and to circumvent issues that would otherwise result in an emergency room visit or readmission to the hospital. Results: A total 429 voice calls were made to 148 patients from November 8, 2016 to February 28, 2019. Overall, 61% (n = 90/148) of the patients were successfully reached by the automated voice system. The patients who were reached by the automated voice system were less likely to be readmitted than those not reached (18.9% vs 41.4%; relative risk (RR) 0.46, 95% CI 0.27-0.77, P = .003). Conclusion: Our study demonstrated that a multidisciplinary approach involving the use of automated telephone calls was associated with decreased hospital readmissions.
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Affiliation(s)
- Charnicia E. Huggins
- BronxCare Health System, Bronx, NY, USA,Charnicia E. Huggins, Pharmacy Department, BronxCare Health System, 1650 Grand Concourse Bronx, Bronx, NY 10457, USA.
| | - Tae Eun Park
- Formerly of BronxCare Health System, Bronx, NY, USA
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46
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Garcia-Carretero R, Vazquez-Gomez O, Luna-Heredia E, Vargas-Rojo B, Fernandez-Cotarelo MJ, Naranjo-Mansilla G. Management of COPD in a Hospital-at-Home Setting at a Peripheral Spanish Hospital: 8-Year Experience. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223211073710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We performed exploratory and descriptive analyses of data from our 8 years of experience in hospital-at-home (HaH) treatment to characterize the clinical profile of patients with exacerbated underlying chronic obstructive pulmonary disease (COPD). Our study had a retrospective research design, using historical electronic health records from patients admitted to the HaH setting between 2012 and 2019. We collected demographic, administrative, and clinical data from patients diagnosed with exacerbated COPD. Between 2012 and 2019, 420 patients diagnosed with acute respiratory infectious disease related to COPD were treated in our HaH setting (18% of all admissions to HaH). Most patients were referred from the Internal Medicine Department. The median length of the hospital stay was 10 days. Most patients (78.8%) presented acute exacerbation with no pneumonia. One-third of the patients required domiciliary oxygen therapy, and half required ventilatory devices for nebulized bronchodilator therapy. All patients were successfully discharged as clinically stable. Our HaH experience in managing patients with exacerbated COPD indicates a means of obtaining cost savings and increased quality of life for patients in which antibiotic and ventilatory therapy is not compromised.
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OUP accepted manuscript. J Antimicrob Chemother 2022; 77:1481-1490. [DOI: 10.1093/jac/dkac047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/18/2022] [Indexed: 11/12/2022] Open
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Mota ANB, Turrini RNT. Evaluación de la usabilidad de una aplicación móvil para pacientes con catéter central de inserción periférica. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.5817.3665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Resumen Objetivo: evaluar la usabilidad de la aplicación Meu PICC para el seguimiento extrahospitalario de pacientes que usan catéter central de inserción periférica por medio del instrumento validado System Usability Scale. Método: estudio transversal que aplicó el System Usability Scale a 30 pacientes que usan catéter central de inserción periférica, diez enfermeros y ocho profesionales en tecnología de la información para evaluar la usabilidad de la aplicación. Resultados: hubo diferencia estadística entre la edad y la usabilidad (p=0,006), así como una correlación negativa entre el tiempo de uso de la aplicación y la usabilidad (p=0,002). Según la escala de clasificación de adjetivos del System Usability Scale, el 40,0% de los pacientes consideró que la aplicación era mejor imaginable y el 33,3% excelente. En cuanto a las enfermeras, el 70,0% consideró que la aplicación era mejor imaginable y el 20,0% excelente; de los profesionales en tecnologías de la información, el 50,0% consideró que la aplicación era mejor imaginable y el 50,0% excelente. Conclusión: la evaluación de usabilidad determinó que los pacientes, enfermeros y profesionales en TIC consideraron que la aplicación era útil para el seguimiento de pacientes que utilizan PICC y la calificaron como adecuada, otorgándole la calificación de mejor imaginable o excelente. Estos resultados confirman el uso de la aplicación Meu PICC en el seguimiento de pacientes que usan PICC fuera del hospital.
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Mota ANB, Turrini RNT. Usability assessment of a mobile app for patients with peripherally inserted central catheters. Rev Lat Am Enfermagem 2022; 30:e3666. [PMID: 36629724 PMCID: PMC9818306 DOI: 10.1590/1518-8345.5817.3666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 02/22/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE to evaluate usability of the Meu PICC (My PICC) app for follow-up of outpatients using peripherally inserted central catheters through the validated System Usability Scale instrument. METHOD a cross-sectional study that applied the System Usability Scale to 30 patients using peripherally inserted central catheters, ten nurses and eight Information and Communication Technology professionals to assess usability of the app. RESULTS a statistical difference was observed between age and usability (p=0.006), as well as a negative correlation between app use time and usability (p=0.002). As per the System Usability Scale adjectival classification, 40.0% and 33.3% of the patients considered the app as the best possible to be imagined and as excellent, respectively. In relation to the nurses, 70.0% considered the app as the best possible to be imagined and 20.0% as excellent; of the Information and Communication Technology professionals, 50.0% considered the app as the best possible to be imagined and the other 50.0%, as excellent. CONCLUSION the usability assessment showed that patients, nurses and ICT professionals considered the app useful for monitoring patients using PICCs and evaluated it as appropriate, evaluating it as the best possible to be imagined or as excellent. These results corroborate use of the Meu PICC app in the monitoring of outpatient use of PICCs.
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Conte M, Schneider B, Varley CD, Streifel AC, Sikka MK. Description and outcomes of patients with substance use disorder with serious bacterial infections who had a multidisciplinary care conference. Ther Adv Infect Dis 2022; 9:20499361221117974. [PMID: 35992495 PMCID: PMC9389031 DOI: 10.1177/20499361221117974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background Patients with substance use disorders (SUDs) and severe bacterial infections requiring prolonged antibiotic therapy represent a significant challenge to providers due to complexity of care coordination required to ensure safe and effective treatment. Our institution developed a patient-centered multidisciplinary discharge planning conference, OPTIONS-DC, to address this challenge. Methods We conducted a retrospective review to evaluates parameters between patients who received an OPTIONS-DC and those who did not. Results We identified 73 patients receiving an OPTIONS-DC and 100 who did not. More patients with an OPTIONS-DC were < 40 years of age (76.7% versus 61.0%, OR = 2.3, 95% CI = 1.1-4.7, p = 0.02), had positive HCV antibody testing (58.9% versus 41.0%, OR = 2.1, 95% CI = 1.1-3.8, p = 0.02), injection drug use (93.2% versus 79.0%, OR = 3.6 95% CI = 1.3-10.1, p = 0.01), used methamphetamines (84.9% versus 72.0%, OR = 2.2, 95% CI = 1.0-4.8, p = 0.04), and started inpatient SUD treatment (80.8% versus 63%, OR = 2.5, 95% CI = 1.2-5.0, p = 0.04) compared with those without a conference. The OPTIONS-DC group was more likely to be diagnosed with bacteremia (74.0% versus 57.0%, OR = 2.1, 95% CI = 1.1-4.1, p = 0.02), endocarditis (39.7% versus21.0%, OR = 2.5, 95% CI = 1.3-4.9, p = 0.03), vertebral osteomyelitis (45.2% versus 15.0%, OR = 4.7, 95% CI = 2.3-9.6, p < 0.01), and epidural abscess (35.6% versus 10.0%, OR = 5.0, 95% CI = 2.2-11.2, p < 0.01) and require 4 weeks or more of antibiotic treatment (97.3% versus 51.1%, OR = 34.1, 95% CI = 7.9-146.7, p = 0.01). Patients with an OPTIONS-DC were also more likely to be admitted between 2019 and 2020 than between 2018 and 2019 (OR = 4.1, 95% CI = 2.1-7.9, p < 0.01). Conclusion Patients with an OPTIONS-DC tended to have more complicated infections and longer courses of antibiotic treatment. While further research on outcomes is needed, patients receiving an OPTIONS-DC were able to successfully complete antibiotic courses across a variety of settings.
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Affiliation(s)
- Michael Conte
- Division of Infectious Diseases, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Brent Schneider
- Division of Infectious Diseases, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Cara D Varley
- Division of Infectious Diseases, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Amber C Streifel
- Department of Pharmacy, Oregon Health & Science University, Portland, OR, USA
| | - Monica K Sikka
- Division of Infectious Diseases, School of Medicine, Oregon Health & Science University, Portland, OR 97239-3098, USA
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