title: Acute dental infections managed in an outpatient parenteral antibiotic program setting: prospective analysis and public health implications.
abstract: The number of Acute Dental Infections (ADI) presenting for emergency department (ED) care are steadily increasing. Outpatient Parenteral Antibiotic Therapy (OPAT) programs are increasingly utilized as an alternative cost-effective approach to the management of serious infectious diseases but their role in the management of severe ADI is not established. This study aims to address this knowledge gap through evaluation of ADI referrals to a regional OPAT program in a large Canadian center.
  
  
  
  All adult ED and OPAT program ADI referrals from four acute care adult hospitals in Calgary, Alberta, were quantified using ICD diagnosis codes in a regional reporting system. Citywide OPAT program referrals were prospectively enrolled over a five-month period from February to June 2014. Participants completed a questionnaire and OPAT medical records were reviewed upon completion of care.
  
  
  
  Of 704 adults presenting to acute care facilities with dental infections during the study period 343 (49%) were referred to OPAT for ADI treatment and 110 were included in the study. Participant mean age was 44 years, 55% were women, and a majority of participants had dental insurance (65%), had seen a dentist in the past six months (65%) and reported prior dental infections (77%), 36% reporting the current ADI as a recurrence. Median length of parenteral antibiotic therapy was 3 days, average total course of antibiotics was 15-days, with a cumulative 1326 antibiotic days over the study period. There was no difference in total duration of antibiotics between broad and narrow spectrum regimes. Conservative cost estimate of OPAT care was $120,096, a cost savings of $597,434 (83%) compared with hospitalization.
  
  
  
  ADI represent a common preventable cause of recurrent morbidity. Although OPAT programs may offer short-term cost savings compared with hospitalization, risks associated with extended antibiotic exposures and delayed definitive dental management must also be gauged.
authors.affiliation: Department of Medicine, University of Calgary, Foothills Medical Centre, 1403, 29th Street NW, Room 303, 3rd Floor North Tower, Calgary, AB, T2N 2T9, Canada. wjaconno@ucalgary.ca.|Division of Infectious Diseases, Department of Medicine, Clinical Lecturer - University of Calgary, Foothills Medical Centre, 1403 29th Street NW, Room 303, 3rd Floor North Tower, Calgary, AB, T2N 2T9, Canada. wjaconno@ucalgary.ca.
authors.forename: William J
authors.initials: WJ
authors.lastname: Connors
authors.affiliation: Dental Public Health Clinics, Alberta Health Services, Chumir Dental Clinic, 6th Floor, 1213 4th Street SW, Calgary, AB, T2R 0X7, Canada.
authors.forename: Heidi H
authors.initials: HH
authors.lastname: Rabie
authors.affiliation: Population, Public and Aboriginal Health, Alberta Health Services, Coronation Plaza 104, 14310 - 111 Avenue, Edmonton, AB, T5M 3Z7, Canada.
authors.forename: Rafael L
authors.initials: RL
authors.lastname: Figueiredo
authors.affiliation: Department of Medicine, University of Calgary, Foothills Medical Centre, 1403, 29th Street NW, Room 303, 3rd Floor North Tower, Calgary, AB, T2N 2T9, Canada.|Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
authors.forename: Donna L
authors.initials: DL
authors.lastname: Holton
authors.affiliation: Department of Medicine, University of Calgary, Foothills Medical Centre, 1403, 29th Street NW, Room 303, 3rd Floor North Tower, Calgary, AB, T2N 2T9, Canada.|Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Parkins
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D000553:Ambulatory Care / Q000191:economics / Q000379:methods; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics; D002170:Canada / Q000453:epidemiology; D003141:Communicable Diseases / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011446:Prospective Studies; D011634:Public Health / Q000191:economics; D009057:Stomatognathic Diseases / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Healthcare costs; Odontogenic infection; Parenteral infusions; Periapical abscess; Public health dentistry