title: Clinical outcomes of a veterans affairs outpatient antimicrobial treatment program.
abstract: OBJECTIVE
  The outpatient parenteral antibiotic therapy (OPAT) program of the Portland Veterans Affairs Medical Center (PVAMC), which has a self-administration model, is staffed by visiting nurses from a specialist infusion company. This study evaluates the clinical outcomes of these patients.
  
  
  METHODS
  This study was a retrospective chart review of 262 patients at PVAMC who had received OPAT between 2007 and 2009. Patients were included only if they received ongoing care at PVAMC. The data collected included conditions and organisms being treated and types and durations of antibiotics used. Clinical cure was defined as documented cure at the end of treatment and 90 days post-OPAT.
  
  
  RESULTS
  One hundred ninety patients of 262 were analyzed. The mean age was 63.2 years. Diabetes was the main comorbid factor (17%). The most common indications for OPAT were osteomyelitis (38%), urinary tract infection (23%), and skin and soft tissue infection (12.6%). Mixed bacterial culture (26%) and Staphylococcus aureus (31%) were the most common organisms treated. Vancomycin was the most frequently used antibiotic (26%) followed by ceftriaxone (12%). The median duration of OPAT was 30 days. The rate of clinical cure at end of treatment observed for all infections treated was 78%, which then decreased to 58% at 90 days post-OPAT (P < 0.001). Patients with diabetes and osteomyelitis had an increased risk of relapse at 90 days post-OPAT on multivariate analysis (P = 0.025).
  
  
  CONCLUSIONS
  An OPAT program using a self-administration model treating patients who were military veterans had successful outcomes. Patients with diabetes and osteomyelitis had worse clinical outcomes 90 days after the completion of OPAT therapy.
authors.affiliation: Division of Infectious Diseases and the Department of Pharmacy, Portland Veterans Affairs Medical Center, Portland, Oregon 97239, USA. shahrzad.mohammadi@
authors.forename: Shahrzad
authors.initials: S
authors.lastname: Mohammadi
authors.forename: Kimberly
authors.initials: K
authors.lastname: MacKay
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Ward
authors.forename: Graeme N
authors.initials: GN
authors.lastname: Forrest
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy*; D002443:Ceftriaxone / Q000008:administration & dosage; D048909:Diabetes Complications / Q000150:complications / Q000188:drug therapy; D018718:Home Infusion Therapy / Q000009:adverse effects; D006801:Humans; D008875:Middle Aged; D009254:Nafcillin / Q000008:administration & dosage; D010019:Osteomyelitis / Q000150:complications / Q000188:drug therapy; D010348:Patient Care Team; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D014640:Vancomycin / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D009254:Nafcillin; D014640:Vancomycin; D002443:Ceftriaxone