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

Norris, Anne; Shrestha, Nabin K.; Allison, Genève; Keller, Sara C.; Bhavan, Kavita; Zurlo, John; Hersh, Adam L.; Gorski, Lisa; Bosso, John A.; Rathore, Mobeen H.; Arrieta, Antonio; Petrak, Russell; Shah, Akshay; Brown, Richard B.; Knight, Shandra L; Umscheid, Craig A.

doi:10.1093/cid/ciy745

Cited by 259 publications

(271 citation statements)

References 142 publications

Supporting

Mentioning

257

Contrasting

Unclassified

Order By: Relevance

“…The administration of laLGPs does not require placement of central catheters, attenuating concerns for contamination, infection, thrombosis, malfunction, and drug abuse or overdose. Additional benefits of laLGPs include prevention of hospital‐associated conditions, the ability of patients to return to work or school faster, care for children or dependents, and resuming activities of daily living 1 …”

Section: Clinical Rationale For Transition From Inpatient To Outpatiementioning

confidence: 99%

“…Several strategies are commonly used to facilitate outpatient transition after initial stabilization during hospitalization. Outpatient parenteral antimicrobial therapy (OPAT) is an effective, safe, and economic strategy of delivering IV antimicrobial therapy after discharge 1,2 . However, maintenance of IV access, need for line care, knowledge of drug administration technique, use of peripherally inserted central catheters (PICC) in a subset of persons who use drugs (PWUD), and need for stable housing often preclude this approach.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Advantages of Outpatient Treatment with Long‐Acting Lipoglycopeptides for Serious Gram‐Positive Infections: A Review

et al. 2020

View full text Add to dashboard Cite

Treatment of serious gram-positive infections presents multiple challenges. Treatment often results in prolonged hospitalization for administration of intravenous antimicrobials and presents an inefficient use of hospital resources. Prolonged hospitalization is typically also unfavorable to patient preferences and potentially subjects patients to additional health care-associated complications. Current strategies of transition to outpatient settings-outpatient parenteral antimicrobial therapy and use of oral antibiotics-often do not adequately serve vulnerable populations for whom there is often no alternative to inpatient therapy. Specifically, people who use drugs, those who cannot reliably adhere to unsupervised treatment (poor mental or physical health), people with complicating life circumstances (e.g., homelessness, incarceration, rural location), and those with inadequate health insurance remain hospitalized for weeks longer than persons without such conditions. We suspected that long-acting lipoglycopeptides (laLGP), such as dalbavancin and oritavancin, may be useful in patient transitions to outpatient settings. Thus, we conducted a search of the peer-reviewed literature using the PubMed, Google Scholar, and MEDLINE databases. Based on accumulating literature, it appears that laLGPs offer a reliable alternative therapeutic strategy that addresses many of the personal and systemic barriers to the traditional transitioning approaches. Current evidence also suggests that these agents may be cost-effective from patient, payer, and hospital perspectives. Barriers to broader use of laLGPs include, among others, a relative lack of prospective data regarding efficacy in serious infections, a narrow United States Food and Drug Administration-approved indication restricted to only acute bacterial skin and skin structure infections, and lack of reimbursement infrastructure for inpatient settings.

show abstract

Section: Clinical Rationale For Transition From Inpatient To Outpatiementioning

confidence: 99%

mentioning

confidence: 99%

Advantages of Outpatient Treatment with Long‐Acting Lipoglycopeptides for Serious Gram‐Positive Infections: A Review

et al. 2020

View full text Add to dashboard Cite

show abstract

“…1 As such, C-I vancomycin is not routinely used in the United States. 21 But C-I vancomycin does offer potential logistical and monitoring advantages in the outpatient setting, although data in this patient population are limited. 5,6,18 Thus the primary objective of this study was to compare nephrotoxicity risk among adult patients who received C-I or I-I vancomycin in an outpatient parenteral antimicrobial therapy (OPAT) program.…”

mentioning

confidence: 99%

Nephrotoxicity Risk and Clinical Effectiveness of Continuous versus Intermittent Infusion Vancomycin Among Patients in an Outpatient Parenteral Antimicrobial Therapy Program

et al. 2020

View full text Add to dashboard Cite

Study Objective To compare rates of nephrotoxicity, time to nephrotoxicity onset, and clinical failure among patients who received continuous infusion (C‐I) or intermittent infusion (I‐I) vancomycin in an outpatient parenteral antimicrobial therapy (OPAT) program. Nephrotoxicity was defined as an increase in serum creatinine greater than 0.5 mg/dl or a 50% increase from baseline for two consecutive measurements while receiving vancomycin during OPAT. Clinical failure was defined as unplanned readmission, extension of therapy, or change in antibiotics. Design Single‐center propensity score‐matched retrospective cohort study. Setting OPAT clinic affiliated with two nearby hospitals. Patients We identified 300 patients who received C‐I or I‐I vancomycin for at least 1 week in the OPAT program between October 1, 2017, and March 31, 2019. Propensity score matching based on age, sex, and infection was performed to minimize differences in patient characteristics between groups. Measurements and Main Results After propensity score matching and exclusion criteria, 74 patients were included in each cohort. Continuous infusion vancomycin was associated with a 3.22‐fold decrease in nephrotoxicity risk (C‐I 6.8% [5/74 patients] vs I‐I 18.9% [14/74 patients]; odds ratio 3.22, 95% confidence interval 1.10–9.46, p=0.027) and a significantly slower onset to nephrotoxicity compared with I‐I (p=0.035). No statistically significant difference in clinical failure rates was observed between the C‐I and I‐I groups (13.5% [10/74 patients] vs 23.0% [17/74 patients], p=0.147). Conclusion In an OPAT setting, C‐I vancomycin was associated with a lower risk of and slower onset to nephrotoxicity than I‐I vancomycin; however, no statistically significant difference in clinical failure rates was observed with C‐I versus I‐I vancomycin.

show abstract

“…The recently released Infectious Diseases Society of America guidelines note these agents as an "unknown but promising" class of agents in the management of ABSSSI. 8 Dalbavancin is a semisynthetic lipoglycopeptide that was approved by the FDA in May 2014 and is indicated for the treatment of adults with ABSSSI caused by gram-positive infections such as Staphylococcus aureus (including MRSA), Streptococcus pyogenes, and Streptococcus agalactiae. In clinical trials, once-weekly IV dalbavancin (two doses) was shown to be noninferior to IV vancomycin followed by an optional oral switch to linezolid for the treatment of ABSSSI.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of dalbavancin on length of stay in acute bacterial skin and skin structure infections

Jones

Hersey

Taylor

et al. 2019

J Am Coll Clin Pharm

View full text Add to dashboard Cite

Purpose Acute bacterial skin and skin structure infections (ABSSSI) are common reasons for hospital admission. A pathway to shift care to the outpatient setting sooner could decrease length of stay (LOS). Our not‐for‐profit community health system has developed a novel practice of partnering with hospitalists as part of a multidisciplinary early discharge of hospitalized patients with dalbavancin for ABSSSI. The primary purpose of this study was to evaluate outcomes associated with this process. Methods This was a retrospective evaluation of an ongoing, prospective process between March 2016 and March 2017. The process involves the hospitalist or infectious diseases pharmacist evaluating patients as possible candidates for dalbavancin therapy. Patients were included if their infection was consistent with cellulitis, abscess, or post‐operative wound infection and they received dalbavancin immediately after discharge from the hospital. The primary outcome was hospital LOS with secondary outcomes of direct cost per case and 30‐day readmission rate. Hospital LOS and 30‐day readmission rate were benchmarked to national averages and internal data from the same time frame the year prior. Results Forty four patients were identified who had received dalbavancin during the time period and met criteria for study inclusion. For the primary outcome of hospital LOS, patients discharged to receive dalbavancin had a mean LOS of 4.3 days similar to published national average (4.95 days in 2011) and lower than internal data (8 days). For secondary outcomes, mean total direct cost per case was $2989 and five patients (11.4%) were readmitted within 30 days similar to published national (16%) and internal data (8.6%). Conclusion Patients discharged to receive dalbavancin had a LOS and overall 30‐day readmission rate below published national data for ABSSSI. Further study is needed to evaluate this process as an effective means to shorten LOS in the management of ABSSSI.

show abstract

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

Cited by 259 publications

References 142 publications

Advantages of Outpatient Treatment with Long‐Acting Lipoglycopeptides for Serious Gram‐Positive Infections: A Review

Advantages of Outpatient Treatment with Long‐Acting Lipoglycopeptides for Serious Gram‐Positive Infections: A Review

Nephrotoxicity Risk and Clinical Effectiveness of Continuous versus Intermittent Infusion Vancomycin Among Patients in an Outpatient Parenteral Antimicrobial Therapy Program

Evaluation of dalbavancin on length of stay in acute bacterial skin and skin structure infections

Contact Info

Product

Resources

About