Low Incidence of <i>Clostridium difficile</i> Infection (CDI) in Patients Treated with Outpatient Parenteral Antimicrobial Therapy (OPAT)

Wong, Ken Koon; Fraser, Thomas G.; Shrestha, Nabin K.; Fatica, Cynthia; Deshpande, Abhishek

doi:10.1017/ice.2014.6

Cited by 11 publications

(7 citation statements)

References 11 publications

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“…35 Our incidence rate of C. difficile-associated diarrhoea (CDAD) in the OPAT setting was 5/400 (1.3%), while in the ertapenem group it was 4/128 (3.1%), higher than in previous studies. 6,36,37 We speculate that the higher incidence of CDAD in the ertapenem group can be accounted for by: (i) its broader spectrum of coverage, compared with other OPAT agents, leading to more disruption of the intestinal microbiota; (ii) probable longer duration of therapy; and (iii) a more complex patient population with various treatment indications. 38 The association between CDAD and ertapenem is Our study has several limitations.…”

Section: Discussionmentioning

confidence: 99%

Comparative outcomes of β-lactam antibiotics in outpatient parenteral antibiotic therapy: treatment success, readmissions and antibiotic switches

Lee

Tam

Weigel

et al. 2015

Journal of Antimicrobial Chemotherapy

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Section: Discussionmentioning

confidence: 99%

Comparative outcomes of β-lactam antibiotics in outpatient parenteral antibiotic therapy: treatment success, readmissions and antibiotic switches

Lee

Tam

Weigel

et al. 2015

Journal of Antimicrobial Chemotherapy

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“…Wong and colleagues report a rate of 0.73%, or 0.26 cases per 1000 patient-days, in all OPAT patients at a single center over a 1-year study period. 3,14 A variety of factors may explain these differences, including different geographical locations and study periods and our selection of patients with only long courses (at least 6 weeks) of IV antibiotics for treatment of BJI, rather than all OPAT patients, as a longer duration of antibiotics is associated with higher rates of C. difficile infections. 15 Uptake of the prescribing of oral antibiotics for BJIs at our institution has been slow.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Opportunities for Oral Antibiotic Therapy in Bone and Joint Infections

et al. 2022

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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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“…Nevertheless, many studies have reported high patient satisfaction with OPAT. 23 Our PDTCP involves identifying patients with issues and concerns and addressing them. Interestingly, these issues and concerns were very similar to the ones presented by Twiddy et al 22 Our PDTCP moved 1 step further, however, by having a care transitions pharmacist or nurse contact patients to address and resolve their concerns related to medication delivery and administration and laboratory monitoring.…”

Section: Discussionmentioning

confidence: 99%

The Impact of a Standardized Discharge Process on 30-Day Readmissions for Patients on Outpatient Parenteral Antibiotic Treatment

2020

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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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Low Incidence of Clostridium difficile Infection (CDI) in Patients Treated with Outpatient Parenteral Antimicrobial Therapy (OPAT)

Cited by 11 publications

References 11 publications

Comparative outcomes of β-lactam antibiotics in outpatient parenteral antibiotic therapy: treatment success, readmissions and antibiotic switches

Comparative outcomes of β-lactam antibiotics in outpatient parenteral antibiotic therapy: treatment success, readmissions and antibiotic switches

Evaluation of Opportunities for Oral Antibiotic Therapy in Bone and Joint Infections

The Impact of a Standardized Discharge Process on 30-Day Readmissions for Patients on Outpatient Parenteral Antibiotic Treatment

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