Assessment of risk factors associated with outpatient parenteral antimicrobial therapy (OPAT) complications: A retrospective cohort study. Issue 1 (11th November 2022)

• Record Type: Journal Article
• Authors: Kaul, Christina M.; Haller, Matthew; Yang, Jenny; Solomon, Sadie; Wang, Yaojie; Wu, Rong; Meng, Yu; Pitts, Robert A.; Phillips, Michael S.
• Is Part Of: Antimicrobial stewardship & healthcare epidemiology. Volume 2:Issue 1(2022)
• Publication Date: 2022-11-11
• Subjects: Anti-infective agents -- Periodicals; Nosocomial infections -- Prevention -- Periodicals; Epidemiology -- Periodicals; 614.44
• DOI: 10.1017/ash.2022.313
• Languages: English
• ISSNs: 2732-494X

Abstract

Abstract: Objective: To characterize factors associated with increased risk of outpatient parenteral antimicrobial therapy (OPAT) complication. Design: Retrospective cohort study. Setting: Four hospitals within NYU Langone Health (NYULH). Patients: All patients aged ≥18 years with OPAT episodes who were admitted to an acute-care facility at NYULH between January 1, 2017, and December 31, 2020, who had an infectious diseases consultation during admission. Results: Overall, 8.45% of OPAT patients suffered a vascular complication and 6.04% suffered an antimicrobial complication. Among these patients, 19.95% had a 30-day readmission and 3.35% had OPAT-related readmission. Also, 1.58% of patients developed a catheter-related bloodstream infection (CRBSI). After adjusting for key confounders, we found that patients discharged to a subacute rehabilitation center (SARC) were more likely to develop a CRBSI (odds ratio [OR], 4.75; P = .005) and to be readmitted for OPAT complications (OR, 2.89; P = .002). Loss to follow-up with the infectious diseases service was associated with increased risks of CRBSI (OR, 3.78; P = .007) and 30-day readmission (OR, 2.59; P < .001). Conclusions: Discharge to an SARC is strongly associated with increased risks of readmission for OPAT-related complications and CRBSI. Loss to follow-up with the infectious diseases service is strongly associated with increased risk of readmission and CRBSI. CRBSI prevention during SARC admission is a critically needed public health intervention. Further work must be done for patients undergoing OPAT to improve their follow-up retention with the infectious diseases service.