1080. OPAT at the End of Life?: Short- and Long-Term Mortality Following Outpatient Parenteral Antibiotic Therapy

BACKGROUND: Outpatient parenteral antimicrobial therapy (OPAT) patients have high rates of adverse drug events, emergency visits, and readmissions. Understanding correlates of mortality during and after OPAT may clarify opportunities to enhance care and meaningfully interpret the clinical profile of patients receiving OPAT. METHODS: We analyzed a cohort of patients enrolled in our OPAT program from 2015 to 2018. Patients were followed to death or December 31, 2018, whichever came first. Using Linkplus, we linked patients to North Carolina death records by name, birth date, and sex. We performed a probabilistic linkage and reviewed any nondeterministic matches. Clinical and demographic data were extracted by chart review. Cause of death was determined by first cause in the state death data, as indexed by ICD-10 code. Mortality rates were tabulated at 90 days and 1 year after treatment start. Predictors of 1-year mortality were assessed by multivariable logistic regression and adjusted for age, sex, Staphylococcus aureus infection, early antibiotic stop, and readmission. RESULTS: Among 729 OPAT courses in the study, the median age was 54 (interquartile range, IQR 44–65) and 60% were male. Seventy-seven deaths occurred during the period at a median 272 days (IQR 89–462), including 7 during OPAT (figure). Mortality at 90 days and 1 year was 3.1% (19 of 617 eligible OPAT courses) and 7.1% (31 of 408), respectively. 90-day mortality was equally due to infection (37%) and cancer (37%), whereas 1-year death was most commonly due to infection (32%). The most commonly reported causes of death at any time during the period were cancer (25%), infection (19%) and cardiovascular disease (17%). Each year increase in age was associated with a 5% relative increase in odds of 1-year death (odds ratio, OR, 1.05, 95% CI 1.02–1.08), and readmission was associated with risk of 1-year death (adjusted OR 7.78, CI 3.46–17.50). CONCLUSION: In this large OPAT cohort, 90-day mortality was 3% and 1-year mortality was 7%. Readmission during OPAT was a strong predictor of 1-year death. Strategies to decrease 1-year mortality may include mitigating readmissions or allocating resources after readmission. The prevalence of cancer-related death suggests an opportunity for OPAT providers and oncologists to collaborate in care of high-risk patients. [Image: see text] DISCLOSURES: All authors: No reported disclosures.