title: Risk Factors for Complications during Outpatient Parenteral Antimicrobial Therapy for Adult Orthopedic and Neurosurgical Infections.
abstract: OBJECTIVE
  Outpatient parenteral antimicrobial therapy (OPAT) is an effective way of treating infections, but complications are common. We identified patient characteristics and OPAT treatment factors associated with increased risk of OPAT-related complications.
  
  
  METHODS
  We used a retrospective cohort design that assessed 337 adult patients treated with OPAT for orthopedic and neurosurgical infections between August 1, 2008 and May 30, 2010. Independent variables included demographics, infection characteristics, lead time factors, OPAT treatment factors, and comorbid conditions. Multivariable log-binomial regression was used to estimate the risk of OPAT complications.
  
  
  RESULTS
  The mean patient age was 55 years (range 19-87), 86% had an orthopedic infection, and 44% were treated with intravenous vancomycin. OPAT complications were seen in 45% (152/337) of the cohort. Risk ratios for OPAT complications were 1.9 (95% confidence interval 1.4-2.5) in patients having no primary care provider, 1.7 (95% confidence interval 1.3-2.1) for those treated with vancomycin.
  
  
  CONCLUSIONS
  Identifying specific patient characteristics and OPAT treatment factors could facilitate OPAT process improvements to reduce the risk of OPAT complications for vulnerable patients.
authors.affiliation: From the Departments of Infectious Diseases and Orthopedics and Rehabilitation, Oregon Health and Science University, Portland.
authors.forename: Kimberly K
authors.initials: KK
authors.lastname: Felder
authors.affiliation: From the Departments of Infectious Diseases and Orthopedics and Rehabilitation, Oregon Health and Science University, Portland.
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Marshall
authors.affiliation: From the Departments of Infectious Diseases and Orthopedics and Rehabilitation, Oregon Health and Science University, Portland.
authors.forename: Louise E
authors.initials: LE
authors.lastname: Vaz
authors.affiliation: From the Departments of Infectious Diseases and Orthopedics and Rehabilitation, Oregon Health and Science University, Portland.
authors.forename: Penelope D
authors.initials: PD
authors.lastname: Barnes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D001847:Bone Diseases / Q000188:drug therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000188:drug therapy*; D010044:Outpatient Clinics, Hospital; D012189:Retrospective Studies; D012307:Risk Factors; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects; D055815:Young Adult; D047090:beta-Lactams / Q000009:adverse effects
chemical_list: D000890:Anti-Infective Agents; D047090:beta-Lactams; D014640:Vancomycin