Section on Infectious Diseases, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina.
Section on Infectious Diseases, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina.
Am J Med Sci. 2021 Feb;361(2):233-237. doi: 10.1016/j.amjms.2020.08.027. Epub 2020 Aug 26.
Outpatient parenteral antimicrobial therapy (OPAT) facilitates early patient discharge, but readmissions prior to completion of therapy may offset its advantages. The objective of this study was to evaluate unplanned readmissions of patients undergoing OPAT at our institution and to identify risk factors. We hypothesized that host factors were most relevant.
We retrospectively identified all patients discharged to receive OPAT during 2017 who experienced at least one unplanned readmission to the hospital prior to its completion. We determined the proportion of patients readmitted, and the causes for readmission. Using a control group, we identified risk factors through multivariate logistic regression analysis.
Out of 684 patients, 17% had an unplanned readmission while receiving OPAT. Causes included worsening infection in 18%, venous access problems in 11%, acute events unrelated to infection in 19%, treatment intolerance in 19%, progression of underlying comorbidity in 20%, and social and other problems in 13%. In multivariate analysis diabetic foot infection (OR 3.24; 95%CI 1.38-8.31; p = 0.01), the presence of chronic kidney disease, decubitus ulcer or heart failure (OR 2.65; 95% CI 1.51-4.70; p < 0.001), and narcotics prescribed at discharge (OR 1.93; 95% CI 1.06-3.60; p = 0.049) were independent risk factors for readmission.
Unplanned hospital readmissions were frequent and due to very heterogeneous causes. Diabetic foot infection, selected comorbidities, and discharge on opioids were identified as independent risk factors. In the efforts to decrease readmissions among patients receiving outpatient parenteral antimicrobial a focus on these high-risk groups is a priority.
门诊患者的肠外抗菌治疗（OPAT）有助于患者提前出院，但在治疗完成前的提前出院可能会抵消其优势。本研究的目的是评估我院接受 OPAT 治疗的患者的非计划再入院情况，并确定其危险因素。我们假设宿主因素是最重要的。
我们回顾性地确定了在 2017 年期间出院接受 OPAT 治疗的所有患者，这些患者在治疗完成之前至少有一次非计划的医院再入院。我们确定了再入院患者的比例以及再入院的原因。通过使用对照组，我们通过多变量逻辑回归分析确定了危险因素。
在 684 名患者中，17%的患者在接受 OPAT 治疗期间发生了非计划再入院。导致再入院的原因包括感染恶化 18%、静脉通路问题 11%、与感染无关的急性事件 19%、治疗不耐受 19%、基础合并症进展 20%以及社会和其他问题 13%。多变量分析显示，糖尿病足感染（OR 3.24；95%CI 1.38-8.31；p=0.01）、存在慢性肾脏病、褥疮或心力衰竭（OR 2.65；95%CI 1.51-4.70；p<0.001）以及出院时开具麻醉药品（OR 1.93；95%CI 1.06-3.60；p=0.049）是再入院的独立危险因素。
非计划的医院再入院较为频繁，且原因多种多样。糖尿病足感染、某些合并症和出院时开具阿片类药物被确定为独立的危险因素。在努力减少接受门诊肠外抗菌治疗的患者的再入院率时，重点关注这些高风险群体是当务之急。
