Epperson Taylor M, Bennett Kiya K, Kupiec Katherine K, Speigel Kathy, Neely Stephen B, Resman-Targoff Beth H, Kinney Karen K, White Bryan P
Department of Pharmacy, Parkland Health, Dallas, Texas.
Clinical and Administrative Sciences, Department of Pharmacy, University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma.
Antimicrob Steward Healthc Epidemiol. 2023 Jan 17;3(1):e15. doi: 10.1017/ash.2022.374. eCollection 2023.
Outpatient antimicrobial therapy (OPAT) is managed by a variety of teams, but primarily through an infectious disease clinic. At our medical center, OPAT monitoring is performed telephonically by pharmacists through a collaborative practice agreement under the supervision of an infectious disease physician. The effect of telephonic monitoring of OPAT by pharmacists on patient outcomes is unknown.
This retrospective cohort study was conducted between July 2017 and July 2018 at a 350-bed academic medical center and included adult patients discharged home on IV antibiotics or oral linezolid. The experimental group comprised patients discharged with a consultation for the OPAT management program, whereas the control group comprised patients discharged home without a consultation. The primary outcome was 30-day readmission.
In total, 399 patients were included: 243 patients in the OPAT management program group and 156 patients in the control group. The 30-day readmission rates were similar in each cohort (20% vs 19%; = .8193); however, the 30-day readmission rates were lower in the OPAT management program for patients discharged on vancomycin (19.4% vs 39.1%; = .004).
We did not find a difference in 30-day readmissions between patients receiving pharmacy-driven OPAT management services and those who did not. Patients receiving vancomycin via OPAT had lower 30-day readmissions when included in the pharmacist-driven OPAT management program. Institutions with limited resources may consider reserving OPAT management services for patients receiving antimicrobials that require pharmacokinetic dosing and/or close monitoring.
门诊抗菌药物治疗（OPAT）由多个团队管理，但主要通过传染病诊所进行。在我们的医疗中心，药剂师在传染病医生的监督下，根据合作医疗协议通过电话对OPAT进行监测。药剂师对OPAT进行电话监测对患者预后的影响尚不清楚。
这项回顾性队列研究于2017年7月至2018年7月在一家拥有350张床位的学术医疗中心进行，纳入了出院回家接受静脉抗生素或口服利奈唑胺治疗的成年患者。实验组包括因OPAT管理项目会诊而出院的患者，而对照组包括未进行会诊而出院回家的患者。主要结局是30天再入院率。
总共纳入了399例患者：OPAT管理项目组243例患者，对照组156例患者。每个队列的30天再入院率相似（20%对19%；P = 0.8193）；然而，对于接受万古霉素出院的患者，OPAT管理项目组的30天再入院率较低（19.4%对39.1%；P = 0.004）。
我们发现接受药剂师主导的OPAT管理服务的患者与未接受该服务的患者在30天再入院率方面没有差异。通过OPAT接受万古霉素治疗的患者，纳入药剂师主导的OPAT管理项目时30天再入院率较低。资源有限的机构可能考虑为接受需要药代动力学给药和/或密切监测的抗菌药物治疗的患者保留OPAT管理服务。
