Successful Establishment of an Antimicrobial Stewardship Program (ASP) for Outpatient Parenteral Antimicrobial Therapy (OPAT)

BACKGROUND: IDSA guidelines for implementing an ASP were published in 2016 with required standards by The Joint Commission for hospitals beginning January, 2017. To date, no guidelines have been established in the US for ASP specific to OPAT. Using current guidelines, along with those proposed for the UK, we developed an ASP program unique to OPAT provided in US physician office infusion centers. METHODS: We identified 5 core elements of the ASP pertinent to OPAT: antimicrobial use based on pathogen susceptibility, duration of OPAT, lack of C. difficile infection, and no emergency department (ED) visit or hospitalization related to OPAT. Other measurable elements included initial patient (pt) education, standard order forms, labs obtained as ordered, adherence to drug stability standards and completion of OPAT as ordered. An assessment tool was developed to measure ASP compliance. Assessments were performed on 50 randomly assigned culture positive patients from each of 5 POICs receiving OPAT in 2016. RESULTS: A total of 250 patients were evaluated for each of the ASP elements. Mean scores were 70.5 for core elements and 24.4 for other elements resulting in 94.9 of 100 possible. Early IV to PO conversion was documented in 8 patients resulting in a reduction of 117 days of OPAT. CONCLUSION: Antimicrobial stewardship is essential in all settings of care, particularly in OPAT with extended durations of therapy. We report the first US OPAT ASP with assessment of compliance. High rates of adherence were achieved in all elements. Implementation of an ASP should be considered in all OPAT settings. DISCLOSURES: R. V. Nathan, Merck: Speaker’s Bureau, Speaker honorarium. Allergan: Speaker’s Bureau, Speaker honorarium. K. Couch, Merck: Speaker’s Bureau, Speaker honorarium. Allergan: Speaker’s Bureau, Speaker honorarium. L. J. Van Anglen, Theravance: Scientific Advisor, Consulting fee