2082. Evaluation of Outpatient Parenteral Antimicrobial Therapy (OPAT) Processes and Outcomes Among Patients Within an Integrated Health System

BACKGROUND: Successful management of outpatient parenteral antimicrobial therapy (OPAT) optimizes outcomes and reduces cost. We examined (i) local OPAT processes and outcomes, (ii) whether OPAT constraints favoring once daily antibiotics promoted suboptimal therapeutic choices, and (iii) whether these data could drive OPAT improvements. METHODS: Patients ≥ 18 years of age who received > 48 hours of OPAT at five infusion centers within a single health-system from January 1, 2018 to March 1, 2018 were eligible for review. The following patient- and treatment-level data were collected: age, gender, drug allergies, laboratory studies and frequency, OPAT indication, infection source, pathogen(s), antibiotic sensitivities, antibiotic therapy and duration, electronic order set used, prescriber specialty, evidence of failed prior oral or intravenous (IV) therapy and IV access type. The primary outcome was OPAT success: the clinical resolution of the infection without relapse within 30 days of antibiotic therapy completion. Secondary outcomes included change in antibiotic therapy due to lack of clinical improvement, adverse drug reactions and IV access complications. A sub-analysis of patients who received daptomycin and/or ertapenem was also performed. OPAT practice was compared with 2018 Infectious Diseases Society of America OPAT guidelines (Norris et al. Clin Infect Dis. 2019;68(1):e1-e35). RESULTS: A total of 108 patients were evaluated. Patient demographics, treatment and outcomes are shown in Table 1. The most common OPAT indications were bone/joint, bacteremia and skin infection. Third-generation cephalosporins, carbapenems and daptomycin were most commonly prescribed. In 34.3% and 24.2% of daptomycin and ertapenem cases, respectively, β-lactam therapy could have been utilized. Assessment of prior failed antibiotic therapy, patient allergies and pathogen-site pairing found 28.7% of patients were eligible for oral therapy upon OPAT initiation. CONCLUSION: Several components of our local OPAT aligned with current guidelines. Initial OPAT patient selection may benefit from added scrutiny. Given the high volume of once daily antibiotics administered for convenience there is an internal opportunity to facilitate multi-daily infusions. [Image: see text] DISCLOSURES: All authors: No reported disclosures.