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217. Broad Spectrum Antibiotic use in Outpatient Parenteral Antibiotic Therapy (OPAT): Opportunities for Antibiotic Stewardship

BACKGROUND: Broad-spectrum antibiotics are often chosen for OPAT due to the convenience of once daily dosing. Current literature suggests that at least 20–30% of these regimens could be narrowed, but this has not been well-defined. METHODS: This was a multicenter, retrospective cohort study of adult...

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Autores principales: Brenon, Jessa R, Shulder, Stephanie, Munsiff, Sonal, Burgoyne, Colleen, Nagel, Angela, Pillinger, Kelly E
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7777981/
http://dx.doi.org/10.1093/ofid/ofaa439.261
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author Brenon, Jessa R
Shulder, Stephanie
Munsiff, Sonal
Burgoyne, Colleen
Nagel, Angela
Pillinger, Kelly E
author_facet Brenon, Jessa R
Shulder, Stephanie
Munsiff, Sonal
Burgoyne, Colleen
Nagel, Angela
Pillinger, Kelly E
author_sort Brenon, Jessa R
collection PubMed
description BACKGROUND: Broad-spectrum antibiotics are often chosen for OPAT due to the convenience of once daily dosing. Current literature suggests that at least 20–30% of these regimens could be narrowed, but this has not been well-defined. METHODS: This was a multicenter, retrospective cohort study of adult inpatients evaluated by the infectious diseases (ID) team with culture positive infections with susceptibilities (C&S) on select intravenous (IV) antibiotics (ampicillin, ampicillin-sulbactam, cefazolin, ceftriaxone, daptomycin, ertapenem, meropenem, nafcillin, penicillin, piperacillin-tazobactam, and vancomycin) enrolled in OPAT and discharged from January 1 - June 30, 2019. Susceptibilities were not required for Actinomyces, Streptococcus spp., Haemophilus spp., anaerobes, Corynebacterium spp., or coagulase-negative Staphylococcus spp. when considered a contaminant by ID. Patients were excluded if the regimen included oral antibiotics (not including rifampin or metronidazole). Primary outcome was the percent of broad-spectrum regimens that could’ve been narrowed based on C&S (alternative available therapy or AAT group). Secondary outcomes included comparison of baseline characteristics and 30-day readmission rates between patients on narrow-spectrum IV antibiotics (NSA) vs AAT group, and the documented reason(s) for broad-spectrum antibiotic selection. RESULTS: 113 patients met study criteria; majority were male (56%), and median age was 60 years. Sixty-four patients were discharged on a broad-spectrum regimen, and 32 (50%) met our AAT definition. Ceftriaxone was used in 75% of these cases (24/32), and mono-microbial Streptococcus spp. infection was the primary indication (54%). AAT group patients were more likely to have Enterobacterales (24.1% vs 1.9% p=< 0.001) or polymicrobial infections (28.1% vs 8.2% p=0.019) compared to NSA group. Reasons for broad-spectrum antibiotic selection were largely undocumented (71%). No significant differences were seen in 30-day readmission rates. CONCLUSION: At our institution, 50% of select IV broad-spectrum OPAT regimens had the potential to be narrowed based on C&S data. This rate is higher than previously reported. It warrants further investigation into the barriers to narrower-spectrum antibiotic prescribing in OPAT. DISCLOSURES: Kelly E. Pillinger, PharmD, BCIDP, Pharmacy Times (Other Financial or Material Support, Speaker)
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spelling pubmed-77779812021-01-07 217. Broad Spectrum Antibiotic use in Outpatient Parenteral Antibiotic Therapy (OPAT): Opportunities for Antibiotic Stewardship Brenon, Jessa R Shulder, Stephanie Munsiff, Sonal Burgoyne, Colleen Nagel, Angela Pillinger, Kelly E Open Forum Infect Dis Poster Abstracts BACKGROUND: Broad-spectrum antibiotics are often chosen for OPAT due to the convenience of once daily dosing. Current literature suggests that at least 20–30% of these regimens could be narrowed, but this has not been well-defined. METHODS: This was a multicenter, retrospective cohort study of adult inpatients evaluated by the infectious diseases (ID) team with culture positive infections with susceptibilities (C&S) on select intravenous (IV) antibiotics (ampicillin, ampicillin-sulbactam, cefazolin, ceftriaxone, daptomycin, ertapenem, meropenem, nafcillin, penicillin, piperacillin-tazobactam, and vancomycin) enrolled in OPAT and discharged from January 1 - June 30, 2019. Susceptibilities were not required for Actinomyces, Streptococcus spp., Haemophilus spp., anaerobes, Corynebacterium spp., or coagulase-negative Staphylococcus spp. when considered a contaminant by ID. Patients were excluded if the regimen included oral antibiotics (not including rifampin or metronidazole). Primary outcome was the percent of broad-spectrum regimens that could’ve been narrowed based on C&S (alternative available therapy or AAT group). Secondary outcomes included comparison of baseline characteristics and 30-day readmission rates between patients on narrow-spectrum IV antibiotics (NSA) vs AAT group, and the documented reason(s) for broad-spectrum antibiotic selection. RESULTS: 113 patients met study criteria; majority were male (56%), and median age was 60 years. Sixty-four patients were discharged on a broad-spectrum regimen, and 32 (50%) met our AAT definition. Ceftriaxone was used in 75% of these cases (24/32), and mono-microbial Streptococcus spp. infection was the primary indication (54%). AAT group patients were more likely to have Enterobacterales (24.1% vs 1.9% p=< 0.001) or polymicrobial infections (28.1% vs 8.2% p=0.019) compared to NSA group. Reasons for broad-spectrum antibiotic selection were largely undocumented (71%). No significant differences were seen in 30-day readmission rates. CONCLUSION: At our institution, 50% of select IV broad-spectrum OPAT regimens had the potential to be narrowed based on C&S data. This rate is higher than previously reported. It warrants further investigation into the barriers to narrower-spectrum antibiotic prescribing in OPAT. DISCLOSURES: Kelly E. Pillinger, PharmD, BCIDP, Pharmacy Times (Other Financial or Material Support, Speaker) Oxford University Press 2020-12-31 /pmc/articles/PMC7777981/ http://dx.doi.org/10.1093/ofid/ofaa439.261 Text en © The Author 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Poster Abstracts
Brenon, Jessa R
Shulder, Stephanie
Munsiff, Sonal
Burgoyne, Colleen
Nagel, Angela
Pillinger, Kelly E
217. Broad Spectrum Antibiotic use in Outpatient Parenteral Antibiotic Therapy (OPAT): Opportunities for Antibiotic Stewardship
title 217. Broad Spectrum Antibiotic use in Outpatient Parenteral Antibiotic Therapy (OPAT): Opportunities for Antibiotic Stewardship
title_full 217. Broad Spectrum Antibiotic use in Outpatient Parenteral Antibiotic Therapy (OPAT): Opportunities for Antibiotic Stewardship
title_fullStr 217. Broad Spectrum Antibiotic use in Outpatient Parenteral Antibiotic Therapy (OPAT): Opportunities for Antibiotic Stewardship
title_full_unstemmed 217. Broad Spectrum Antibiotic use in Outpatient Parenteral Antibiotic Therapy (OPAT): Opportunities for Antibiotic Stewardship
title_short 217. Broad Spectrum Antibiotic use in Outpatient Parenteral Antibiotic Therapy (OPAT): Opportunities for Antibiotic Stewardship
title_sort 217. broad spectrum antibiotic use in outpatient parenteral antibiotic therapy (opat): opportunities for antibiotic stewardship
topic Poster Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7777981/
http://dx.doi.org/10.1093/ofid/ofaa439.261
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