title: Outcomes and cost minimisation associated with outpatient parenteral antimicrobial therapy (OPAT) for foot infections in people with diabetes.
abstract: OBJECTIVE
  To determine clinical outcomes in patients with diabetic foot infections receiving outpatient parenteral antimicrobial therapy (OPAT), to evaluate cost savings from the use of OPAT and to analyse demographic, clinical and laboratory data that may predict OPAT failure.
  A retrospective cohort analysis was conducted between 1 January 2007 and 7 July 2012 at a tertiary referral hospital in metropolitan Sydney. Patients with diabetic foot infection were identified from the outpatient parenteral antimicrobial therapy database. Demographic, clinical, laboratory and operative report data were obtained from patient charts and electronic medical records. Potential cost savings were calculated on the estimated cost of expenditure versus the expected savings. Linear regression was used to explore outcomes associated with outpatient parenteral antimicrobial therapy failure.
  
  
  RESULTS
  Fifty-nine patients were identified over the 5-year study period. The outpatient parenteral antimicrobial therapy success rate for diabetic foot infections was 88%. Following the resolution of the primary episode of infection, new infective episodes within the study period were high (n = 26, 44%). Regression analysis of variables for OPAT failure failed to indicate any factors reaching statistical significance. A total of 1569 days were saved by using outpatient parenteral antimicrobial therapy for an estimated total cost saving of $983,645 or $16,672 per patient.
  
  
  CONCLUSIONS
  Outpatient intravenous therapy for diabetic foot infections is an effective mode of treatment that can contribute to significant healthcare savings. High re-infection rates associated with diabetes foot ulceration in this population underline the need for close monitoring and management of these patients in multidisciplinary high-risk foot setting.
authors: Department of Podiatric Medicine, High Risk Foot Service, Liverpool Hospital, Locked Bag 7103, Liverpool, Sydney, New South Wales, Australia.|LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, Sydney, New South Wales, Australia.
authors: Matthew
authors: M
authors: Malone
authors: The Demand Management Unit, Liverpool Hospital, Locked Bag 7103, Liverpool, Sydney, New South Wales, Australia.
authors: Dana
authors: D
authors: West
authors: LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, Sydney, New South Wales, Australia.
authors: Wei
authors: W
authors: Xuan
authors: LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, Sydney, New South Wales, Australia.|Department of Diabetes and Endocrinology, Liverpool Hospital, Locked Bag 7103, Liverpool, Sydney, New South Wales, Australia.
authors: Namson S
authors: NS
authors: Lau
authors: Department of Infectious Diseases, Liverpool Hospital, Locked Bag 7103, Liverpool, Sydney, New South Wales, Australia.
authors: Michael
authors: M
authors: Maley
authors: LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, Sydney, New South Wales, Australia.|Department of Ambulatory Care, Liverpool Hospital, Locked Bag 7103, Liverpool, Sydney, New South Wales, Australia.
authors: Hugh G
authors: HG
authors: Dickson
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000191:economics; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D015331:Cohort Studies; D017046:Cost Savings; D003365:Costs and Cost Analysis; D017719:Diabetic Foot / Q000150:complications* / Q000191:economics / Q000382:microbiology / Q000601:surgery; D016527:Drug Costs; D057286:Electronic Health Records; D005260:Female; D017048:Health Care Costs; D006786:Hospitals, Urban; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010044:Outpatient Clinics, Hospital; D012008:Recurrence; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000150:complications / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology; D062606:Tertiary Care Centers
chemical_list: D000890:Anti-Infective Agents
keywords: diabetic foot; infection; intravenous antimicrobial therapy; ulceration