在对门诊胃肠外抗菌治疗（OPAT）项目进行系统性强化后，医院再入院率降低。
Decreased hospital readmissions after programmatic strengthening of an outpatient parenteral antimicrobial therapy (OPAT) program.
作者信息
Agnihotri Gaurav, Gross Alan E, Seok Minji, Yen Cheng Yu, Khan Farah, Ebbitt Laura M, Gay Cassandra, Bleasdale Susan C, Sikka Monica K, Trotter Andrew B
机构信息
College of Medicine, University of Illinois at Chicago, Chicago, Illinois.
Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois.
出版信息
Antimicrob Steward Healthc Epidemiol. 2023 Feb 21;3(1):e33. doi: 10.1017/ash.2022.330. eCollection 2023.
OBJECTIVE
To determine whether a structured OPAT program supervised by an infectious disease physician and led by an OPAT nurse decreased hospital readmission rates and OPAT-related complications and whether it affected clinical cure. We also evaluated predictors of readmission while receiving OPAT.
PATIENTS
A convenience sample of 428 patients admitted to a tertiary-care hospital in Chicago, Illinois, with infections requiring intravenous antibiotic therapy after hospital discharge.
METHODS
In this retrospective, quasi-experimental study, we compared patients discharged on intravenous antimicrobials from an OPAT program before and after implementation of a structured ID physician and nurse-led OPAT program. The preintervention group consisted of patients discharged on OPAT managed by individual physicians without central program oversight or nurse care coordination. All-cause and OPAT-related readmissions were compared using the χ test. Factors associated with readmission for OPAT-related problems at a significance level of < .10 in univariate analysis were eligible for testing in a forward, stepwise, multinomial, logistic regression to identify independent predictors of readmission.
RESULTS
In total, 428 patients were included in the study. Unplanned OPAT-related hospital readmissions decreased significantly after implementation of the structured OPAT program (17.8% vs 7%; = .003). OPAT-related readmission reasons included infection recurrence or progression (53%), adverse drug reaction (26%), or line-associated issues (21%). Independent predictors of hospital readmission due to OPAT-related events included vancomycin administration and longer length of outpatient therapy. Clinical cure increased from 69.8% before the intervention to 94.9% after the intervention ( < .001).
CONCLUSION
A structured ID physician and nurse-led OPAT program was associated with a decrease in OPAT-related readmissions and improved clinical cure.
目的
确定由传染病医生监督、OPAT护士主导的结构化OPAT项目是否能降低医院再入院率和OPAT相关并发症，以及是否会影响临床治愈情况。我们还评估了接受OPAT治疗期间再入院的预测因素。
患者
选取伊利诺伊州芝加哥一家三级护理医院收治的428例患者作为便利样本，这些患者出院后因感染需要静脉抗生素治疗。
方法
在这项回顾性、准实验研究中，我们比较了在结构化感染病医生和护士主导的OPAT项目实施前后，从OPAT项目出院并接受静脉抗菌药物治疗的患者情况。干预前组由在没有中央项目监督或护士护理协调的情况下由个别医生管理的OPAT出院患者组成。使用χ检验比较全因再入院率和与OPAT相关的再入院率。在单因素分析中，与OPAT相关问题再入院显著相关（P<0.10）的因素有资格进行向前逐步多项逻辑回归测试，以确定再入院的独立预测因素。
结果
该研究共纳入428例患者。结构化OPAT项目实施后，计划外的与OPAT相关的医院再入院率显著降低（17.8%对7%；P = 0.003）。与OPAT相关的再入院原因包括感染复发或进展（53%）、药物不良反应（26%）或与导管相关的问题（21%）。因OPAT相关事件导致医院再入院的独立预测因素包括万古霉素的使用和门诊治疗时间延长。临床治愈率从干预前的69.8%提高到干预后的94.9%（P<0.001）。
结论
由感染病医生和护士主导的结构化OPAT项目与OPAT相关再入院率的降低和临床治愈率的提高相关。
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