Risk Factors for Readmission in Patients with Outpatient Parenteral Antimicrobial Therapy

Abstract

BackgroundOutpatient parenteral antimicrobial therapy (OPAT) is a practical and effective way of delivering antimicrobial therapy, but may be associated with significant risk for hospital readmission. This study aimed to elucidate risk factors related to 30-day readmissions in patients who were discharged with OPAT at Mount Sinai Beth Israel (MSBI).MethodsThis IRB approved retrospective cohort study included patients who were at least 18 years or older, admitted to MSBI from August 2015 to March 2016, and discharged to receive OPAT. Subjects were identified using the vascular access team’s monthly reports of peripherally inserted central catheter (PICC) and midline insertion; there was no standardized OPAT program at MSBI. Patients with intravenous antibiotics prescribed for chronic suppression or planned readmission within 30 days were excluded. Information on baseline demographic, clinical, and treatment parameters were collected. The main outcome was readmission to the hospital within 30 days from previous hospital discharge. Univariate and logistic regression analyses were performed to determine predictors of 30-day readmission.ResultsThere were a total of 200 patients included in the analysis; the median age was 60 years, 66% were male, and the median Charlson score was 2. Diabetes, peripheral vascular disease, and chronic obstructive pulmonary disease were the most common comorbidities. A total of 155 (78%) patients received a PICC line; the remainder was discharged with a midline. The most common medications prescribed for OPAT included cephalosporins (41%), vancomycin (31%), carbapenems (23%), and penicillins (16%). A total of 42 patients (21%) were readmitted within 30 days after previous discharge. Independent predictors of readmission on logistic regression analyses were (P < 0.05): discharge to a skilled nursing facility or subacute rehabilitation center, diabetes without end-organ damage, and PICC line usage.ConclusionReadmissions are common in patients discharged with OPAT. Recognizing predictors of readmission may help determine strategies to optimize care.Disclosures All authors: No reported disclosures.