1940. Outcomes Among Patients Enrolled in an Outpatient Parenteral Antibiotic Therapy Program at an Academic Medical Center

BACKGROUND: Outpatient parenteral antibiotic therapy (OPAT) is a key part of the treatment of severe infection. One indication for OPAT is methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Few data have been published regarding long-term follow-up and outcomes among patients in an OPAT program (OPAT-P). We describe OPAT-P outcomes at an academic medical center with a focus on MRSA bacteremia (MRSA-B). METHODS: A retrospective chart review was performed. Two cohorts of patients were studied. The first comprised all adult inpatients enrolled in OPAT-P at discharge from July 2016 to December 2017. The second cohort was a subset of these patients treated for MRSA-B. Outcomes (including readmissions, emergency room [ER] visits, microbiological recurrences, and death) were compared with outcomes among non-OPAT-P patients discharged on IV antibiotics for MRSA-B between January 2015 and December 2017. Statistical measures including chi squared tests or Fisher’s exact tests were used. RESULTS: Five hundred sixty-one patients were enrolled in OPAT-P from July 2016 to December 2017. Common indications were osteomyelitis (n = 219, 39%), bacteremia (n = 73, 13%), and endocarditis (n = 73, 13%); 22% had polymicrobial infection. Sixty-one (11%) were rehospitalized and 24 (4%) had an ER visit for an infectious or OPAT issue while on therapy. Fifty-one adverse events occurred that did not result in ER visit or a readmission. Ninety-three (17%) required antibiotic dose changes. Twenty-five patients were treated for MRSA-B; 83 additional non-OPAT-P patients were discharged on IV therapy for MRSA-B from January 2015 to December 2017. Common sources of bacteremia included central line (n = 24, 22%), cellulitis (n = 18, 16%), and osteomyelitis (n = 9, 8%). No MRSA-B patients died within 30 days of discharge. Overall 6-month readmission and ER visit rates did not differ based on OPAT-P enrollment (54%, P = 0.46 and 57%, P = 0.43, respectively). Three of 25 (12%) MRSA-B OPAT-P patients and 9/83 (74%) MRSA-B non-OPAT-P patients were readmitted for OPAT or infectious complications (P = NS). Microbiological recurrence was rare. CONCLUSION: Adverse events in OPAT are common and antibiotic monitoring is crucial for OPAT safety. A dedicated OPAT-P has the potential to proactively identify adverse events and change therapy to prevent unplanned admission or ER visit. Further data are needed to clarify whether an OPAT-P may improve MRSA-B post-discharge outcomes. DISCLOSURES: All authors: No reported disclosures.