Boeun Lee1, Idy Tam1, Bernard Weigel2, Janis L Breeze3, Jessica K Paulus4, Jason Nelson3, Genève M Allison5. 1. Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA. 2. Tufts University, Medford, MA, USA. 3. Tufts Clinical Translational Sciences Institute, Boston, MA, USA Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA. 4. Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA. 5. Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA gallison@tuftsmedicalcenter.org.
Abstract
OBJECTIVES: β-Lactam antibiotics are commonly used in outpatient parenteral antimicrobial therapy (OPAT), but data regarding outcomes of long-term therapy are limited. The purpose of this study was to compare treatment success, readmission and antibiotic switch rates in patients treated with β-lactam antibiotics as OPAT. METHODS: We carried out a retrospective review of all patients, discharged from Tufts Medical Center with cefazolin, ceftriaxone, ertapenem or oxacillin, between January 2009 and June 2013. A competing risks analysis was used to compare the cumulative incidence of first occurrence of treatment success, antibiotic switch and 30 day readmission for each drug. RESULTS: Four hundred patients were identified (cefazolin n = 38, ceftriaxone n = 104, ertapenem n = 128 and oxacillin n = 130). Baseline demographics were similar. Treatment success rates were higher for ceftriaxone and ertapenem (cefazolin 61%, ceftriaxone 81%, ertapenem 73% and oxacillin 58%; P < 0.001). Thirty-day all-cause readmissions were similar (cefazolin 21%, ceftriaxone 14%, ertapenem 20% and oxacillin 15%; P = 0.46). In 400 OPAT courses, 37 out of 50 antibiotic switches were accomplished without readmission. Adverse drug events (ADEs) were the most common reason for outpatient antibiotic switches (31/37, 84%). The ADE rate was higher for the oxacillin group (cefazolin 2.0 versus ceftriaxone 1.5 versus ertapenem 2.9 versus oxacillin 8.4 per 1000 OPAT days; P < 0.001). CONCLUSIONS: OPAT with β-lactam antibiotics is effective, but antibiotic switches for adverse events were more frequent with oxacillin use. Clinicians should be cognizant of the risk of readmissions and ADEs in OPAT patients, as the value of OPAT lies in reducing patient morbidity and readmissions by managing ADEs and preventing clinical failures.
OBJECTIVES: β-Lactam antibiotics are commonly used in outpatient parenteral antimicrobial therapy (OPAT), but data regarding outcomes of long-term therapy are limited. The purpose of this study was to compare treatment success, readmission and antibiotic switch rates in patients treated with β-lactam antibiotics as OPAT. METHODS: We carried out a retrospective review of all patients, discharged from Tufts Medical Center with cefazolin, ceftriaxone, ertapenem or oxacillin, between January 2009 and June 2013. A competing risks analysis was used to compare the cumulative incidence of first occurrence of treatment success, antibiotic switch and 30 day readmission for each drug. RESULTS: Four hundred patients were identified (cefazolin n = 38, ceftriaxone n = 104, ertapenem n = 128 and oxacillin n = 130). Baseline demographics were similar. Treatment success rates were higher for ceftriaxone and ertapenem (cefazolin 61%, ceftriaxone 81%, ertapenem 73% and oxacillin 58%; P < 0.001). Thirty-day all-cause readmissions were similar (cefazolin 21%, ceftriaxone 14%, ertapenem 20% and oxacillin 15%; P = 0.46). In 400 OPAT courses, 37 out of 50 antibiotic switches were accomplished without readmission. Adverse drug events (ADEs) were the most common reason for outpatient antibiotic switches (31/37, 84%). The ADE rate was higher for the oxacillin group (cefazolin 2.0 versus ceftriaxone 1.5 versus ertapenem 2.9 versus oxacillin 8.4 per 1000 OPAT days; P < 0.001). CONCLUSIONS: OPAT with β-lactam antibiotics is effective, but antibiotic switches for adverse events were more frequent with oxacillin use. Clinicians should be cognizant of the risk of readmissions and ADEs in OPAT patients, as the value of OPAT lies in reducing patient morbidity and readmissions by managing ADEs and preventing clinical failures.
Authors: Brent W Wieland; Jodie R Marcantoni; Kerry M Bommarito; David K Warren; Jonas Marschall Journal: Clin Infect Dis Date: 2011-12-05 Impact factor: 9.079
Authors: Ann L N Chapman; R Andrew Seaton; Mike A Cooper; Sara Hedderwick; Vicky Goodall; Corienne Reed; Frances Sanderson; Dilip Nathwani Journal: J Antimicrob Chemother Date: 2012-01-31 Impact factor: 5.790
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: E Forestier; S Gros; D Peynaud; M Levast; D Boisseau; C Ferry-Blanco; A Labe; C Lecomte; O Rogeaux Journal: Med Mal Infect Date: 2012-08-25 Impact factor: 2.152
Authors: J Alexander Viehman; Louise-Marie Oleksiuk; Kathleen R Sheridan; Karin E Byers; Peimei He; Bonnie A Falcione; Ryan K Shields Journal: Antimicrob Agents Chemother Date: 2016-04-22 Impact factor: 5.191
Authors: Sara C Keller; Deborah Williams; Mitra Gavgani; David Hirsch; John Adamovich; Dawn Hohl; Ayse P Gurses; Sara E Cosgrove Journal: Clin Infect Dis Date: 2018-01-06 Impact factor: 9.079
Authors: Maya Beganovic; Jaclyn A Cusumano; Vrishali Lopes; Kerry L LaPlante; Aisling R Caffrey Journal: Open Forum Infect Dis Date: 2019-06-06 Impact factor: 3.835
Authors: Rachel S Britt; Mary T LaSalvia; Simi Padival; Parth Patel; Christopher McCoy; Monica V Mahoney Journal: Open Forum Infect Dis Date: 2019-11-19 Impact factor: 3.835