Outpatient parenteral antimicrobial therapy at large Veterans Administration medical center.
OBJECTIVE
To evaluate our outpatient parenteral antimicrobial therapy (OPAT) program to determine its impact on infection management in a facility notable for high patient comorbidity and a large catchment area that includes most of Southern California.


METHODS
Retrospective chart review.


METHODS
We reviewed all episodes of patients receiving OPAT from our institution from 2006 through 2009 for patient utilization characteristics and assessment of complications.


RESULTS
A total of 333 patients received 393 courses of OPAT for a mean of 21.1 days. Diabetes mellitus (53.5%), psychiatric disease (39%), and chronic kidney disease (31%) were common; more than half the patients lived more than 20 miles from our medical center. Osteomyelitis (39.7%) and bacteremia (19.3%) accounted for the majority of OPAT indications. Staphylococcus aureus (36.4%) was the most frequent infecting organism, and vancomycin (37.4%) was the most frequently prescribed medication. Complications including hospital readmission, adverse drug reactions, or line-related complications were noted in 96 of 393 (24.4%) episodes, but most were minor, reversible, or not directly related to the OPAT given. Serious line-related complications that required hospital readmission were noted in only 6 (1.5%) episodes. OPAT was completed as planned in 313 (79.6%) episodes; end-stage renal disease was associated with OPAT noncompletion in multivariable analysis (odds ratio = 2.20, P = .047). We estimated that OPAT saved our medical center $4 million per year.


CONCLUSIONS
Despite our patients' high level of comorbidity and our facility's large catchment area, we were able to deliver OPAT successfully and safely with significant cost savings.
Andrew
A
Lai
Thuong
T
Tran
Hien M
HM
Nguyen
Jacob
J
Fleischmann
David O
DO
Beenhouwer
Christopher J
CJ
Graber
D000553:Ambulatory Care; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D002140:California; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D008485:Medical Audit; D055118:Medication Adherence; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010359:Patient Readmission; D012189:Retrospective Studies
D000890:Anti-Infective Agents