title: Mandatory infectious diseases approval of outpatient parenteral antimicrobial therapy (OPAT): clinical and economic outcomes of averted cases.
abstract: OBJECTIVE
  The use of outpatient parenteral antimicrobial therapy (OPAT) has been increasing worldwide due to its evident clinical utility; however, there is also concern about overuse and increased risk to patients in terms of antibiotic toxicity and intravenous line-associated complications. At our university-affiliated county teaching hospital with mandatory Infectious Diseases (ID) approval for all OPAT courses, we looked at clinical outcomes and cost savings of patients denied OPAT.
  
  
  METHODS
  Electronic medical records of patients denied OPAT were retrospectively reviewed. Demographic, medical, infection-specific and drug-specific data were collected for each patient, including the regimen ultimately recommended by ID in lieu of OPAT. Patients were determined to have clinical cure, probable cure or treatment failure based on resolution or recurrence of infection for up to 1 year after OPAT denial. The amount of money saved in direct OPAT costs in these patients was calculated.
  
  
  RESULTS
  Fifty-six patients were denied OPAT during the study period and were discharged with either oral or no additional antibiotics. Clinical cure was documented in 42 patients (75%), probable cure in 7 patients (12.5%) and treatment failure in 7 patients (12.5%). Of the seven treatment failures, only one patient (1.8%) was deemed to be a true failure after thorough chart review. Overall, the estimated OPAT-specific cost saving was $215 424 or $3847 per patient.
  
  
  CONCLUSIONS
  Mandatory ID approval of all OPAT courses can decrease healthcare costs while maintaining good clinical outcomes.
authors.affiliation: Section of Infectious Diseases, Rush University Medical Center, 600 S Paulina St., Suite 143, Chicago, IL 60612, USA.
authors.forename: Marjorie M
authors.initials: MM
authors.lastname: Conant
authors.affiliation: Purdue University College of Pharmacy, Wishard Health Services/Eskenazi Health, 720 Eskenazi Avenue, Indianapolis, IN 46202, USA serdman@purdue.edu.
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Erdman
authors.affiliation: Division of Infectious Diseases, St John Hospital and Medical Center, Mack Office Building, 19251 Mack Avenue, Suite 340, Grosse Pointe Woods, MI 48236, USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Osterholzer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003141:Communicable Diseases / Q000188:drug therapy* / Q000382:microbiology; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006785:Hospitals, University; D006801:Humans; D007196:Indiana; D007263:Infusions, Parenteral / Q000009:adverse effects / Q000191:economics; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010045:Outpatients; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D016312:Treatment Refusal; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents
keywords: OPAT; antimicrobial stewardship; healthcare costs; mandatory approval