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Outpatient Parenteral Antimicrobial Therapy Practices among Adult Infectious Disease Physicians

Published online by Cambridge University Press:  10 May 2016

Michael A. Lane ,
Jonas Marschall ,
Susan E. Beekmann ,
Philip M. Polgreen ,
Ritu Banerjee ,
Adam L. Hersh  and
Hilary M. Babcock
Michael A. Lane*
Affiliation:
Department of Internal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
Jonas Marschall
Affiliation:
Department of Internal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
Susan E. Beekmann
Affiliation:
Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
Philip M. Polgreen
Affiliation:
Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
Ritu Banerjee
Affiliation:
Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
Adam L. Hersh
Affiliation:
Pediatric Infectious Diseases, University of Utah, Salt Lake City, Utah
Hilary M. Babcock
Affiliation:
Department of Internal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
*
Washington University School of Medicine, Campus Box 8051, 660 South Euclid Avenue, St. Louis, MO 63110 ([email protected]).
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Extract

Objective

To identify current outpatient parenteral antibiotic therapy practice patterns and complications.

Methods

We administered an 11-question survey to adult infectious disease physicians participating in the Emerging Infections Network (EIN), a Centers for Disease Control and Prevention–sponsored sentinel event surveillance network in North America. The survey was distributed electronically or via facsimile in November and December 2012. Respondent demographic characteristics were obtained from EIN enrollment data.

Results

Overall, 555 (44.6%) of EIN members responded to the survey, with 450 (81%) indicating that they treated 1 or more patients with outpatient parenteral antimicrobial therapy (OPAT) during an average month. Infectious diseases consultation was reported to be required for a patient to be discharged with OPAT by 99 respondents (22%). Inpatient (282 [63%] of 449) and outpatient (232 [52%] of 449) infectious diseases physicians were frequently identified as being responsible for monitoring laboratory results. Only 26% (118 of 448) had dedicated OPAT teams at their clinical site. Few infectious diseases physicians have systems to track errors, adverse events, or “near misses” associated with OPAT (97 [22%] of 449). OPAT-associated complications were perceived to be rare. Among respondents, 80% reported line occlusion or clotting as the most common complication (occurring in 6% of patients or more), followed by nephrotoxicity and rash (each reported by 61%). Weekly laboratory monitoring of patients who received vancomycin was reported by 77% of respondents (343 of 445), whereas 19% of respondents (84 of 445) reported twice weekly laboratory monitoring for these patients.

Conclusions

Although use of OPAT is common, there is significant variation in practice patterns. More uniform OPAT practices may enhance patient safety.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 7 , July 2014 , pp. 839 - 844
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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