Assessing Safety and Outcomes of the Atlanta Veterans Affairs Medical Center's Outpatient Parenteral Antimicrobial Program Público
Rich, William (Spring 2023)
Abstract
Background
The Atlanta VA medical center (AVAMC) utilizes outpatient parenteral antimicrobial therapy (OPAT) to treat a wide range of infections which do not require hospitalization. OPAT has similar outcomes to inpatient care while reducing costs, increasing patient satisfaction, and increasing patient autonomy.
Objective
In this study, the authors seek to understand the population of patients in the AVAMC OPAT program and explore risk factors for hospital readmission, adverse drug events (ADEs), and failure of therapy.
Methods
The medical charts of OPAT patients receiving care between January 1, 2019 and June 30, 2022 were reviewed. We included patients who completed their OPAT course at home and who were over the age of 18. We collected information about demographics, incident hospitalization, hospitalization antimicrobials, OPAT indication, infectious agent, OPAT antimicrobials, ADEs, patient follow-up, and resolution of infection. We also conducted univariate and multivariate logistic regression analyses of patients with a musculoskeletal condition (MSK) with no change in their OPAT course.
Results
Full Cohort
Among our full cohort, diabetes was associated with an increased risk of failure with a risk ratio (RR) of 1.68 (95% CI 1.01-2.77). Patients who received follow-up had a RR of 0.39 (95% CI: 0.21-0.73) for rehospitalization compared to patients who did not receive follow-up.
MSK Cohort
For patients in the MSK group with diabetes, risk of failure was 1.50 times higher than those without diabetes (95% CI: 0.67-3.34), however the association was not statistically significant. The RR for rehospitalization was 0.23 (95% CI: 0.06-0.82) for patients who received follow-up compared to patients who did not receive follow-up.
Conclusion
More research needs to be conducted on the use of OPAT in patients with diabetes. We also want to emphasize the importance of prompt patient follow-up to reduce the risk of rehospitalization among OPAT patients. We plan on collecting more data and conducting further analyses on the full cohort and on subsets of patients.
Table of Contents
Background. 1
Methods 5
Results 9
Discussion. 11
Conclusion. 13
Tables 15
References 31
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