Predictors of adverse safety events and unscheduled care among an outpatient parenteral antimicrobial therapy (OPAT) patient cohort

Kaylyn N Billmeyer; Jennifer K Ross; Elizabeth B Hirsch; Michael D Evans; Susan E Kline; Alison L Galdys

doi:10.1177/20499361231179668

Predictors of adverse safety events and unscheduled care among an outpatient parenteral antimicrobial therapy (OPAT) patient cohort

Ther Adv Infect Dis. 2023 Jun 12:10:20499361231179668. doi: 10.1177/20499361231179668. eCollection 2023 Jan-Dec.

Authors

Kaylyn N Billmeyer¹, Jennifer K Ross², Elizabeth B Hirsch¹, Michael D Evans³, Susan E Kline^{2

4}, Alison L Galdys^{5

2}

Affiliations

¹ University of Minnesota College of Pharmacy, Minneapolis, MN, USA.
² M Health Fairview University of Minnesota Medical Center, Minneapolis, MN, USA.
³ Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA.
⁴ University of Minnesota Medical School, Minneapolis, MN, USA.
⁵ Division of Infectious Diseases and International Medicine, Department of Medicine, Medical School, University of Minnesota, 420 Delaware Street SE, Mayo Mail Code 250, Minneapolis, MN 55455, USA.

Abstract

Background: Select circumstances require outpatient parenteral antimicrobial therapy (OPAT). The potency of OPAT agents presents an increased risk of adverse events and unscheduled medical care. We analyzed these outcomes among OPAT recipients as part of the implementation of a collaborative OPAT program.

Methods: Adult patients discharged home from an academic hospital with OPAT between January 2019 and June 2021 were included in this retrospective cohort; participants discharged between June 2020 and June 2021 were part of the collaborative OPAT program. Patients with cystic fibrosis were excluded. Data on patient characteristics and outcomes were collected from electronic medical records by two reviewers. Multivariable analysis was conducted to identify predictors of vascular access device (VAD) complications, adverse drug events (ADEs), and OPAT-related emergency department (ED) visits and rehospitalizations.

Results: Among 265 patients included in the cohort, 57 (21.5%) patients experienced a VAD complication; obesity [odds ratio (OR): 3.32; 95% confidence interval (CI): 1.38-8.73; p = 0.01) and multi-drug therapy (OR: 2.56; 95% CI: 1.21-5.39; p = 0.01) were associated with an increased odds of VAD complication. Eighty-two (30.9%) participants experienced an ADE; 30 (11.3%) experienced a severe/serious ADE. Lipo/glycopeptide receipt, (OR: 5.28; 95% CI: 1.89-15.43; p < 0.01) and Black/African American race (OR: 4.85; 95% (CI): 1.56-15.45; p < 0.01) were associated with an increased odds of severe/serious ADE. Inclusion in the OPAT collaborative was associated with a decreased odds of severe/serious ADE (OR: 0.26; 95% CI: 0.08-0.77; p = 0.01). Fifty-eight (21.9%) patients experienced an OPAT-related ED visit and 53 (20.0%) experienced an OPAT-related rehospitalization. VAD complication (OR: 2.37; 95% (CI): 1.15-4.86, p = 0.02) and ADEs (OR: 2.19; CI: 1.13-4.22; p = 0.02) were associated with OPAT-related ED visits. ADE was associated with 90-day OPAT-related rehospitalization (OR: 3.21; (CI): 1.59-6.58; p < 0.01).

Conclusion: Adverse safety events and OPAT-related unscheduled care occurred often in our cohort. A structured OPAT program that includes ID pharmacist antibiotic reconciliation may reduce rates of ADEs.

Keywords: OPAT; outpatient parenteral antibiotic therapy.