Bradley Abby C, Wingler Mary Joyce B, Artman Katherine L, Ward Lori M, Lucar Jose
Department of Pharmacy, University of Mississippi Medical Center, Jackson, MS, USA.
Department of Pharmacy, Ascension St. Vincent's East, Birmingham, AL, USA.
Ther Adv Infect Dis. 2023 Sep 1;10:20499361231195966. doi: 10.1177/20499361231195966. eCollection 2023 Jan-Dec.
Outpatient parenteral antimicrobial therapy (OPAT), when required, is beneficial to patients and healthcare systems by reducing hospital length-of-stay, providing cost savings, and improving patient satisfaction.
The purpose of this study is to determine readmission rates and associated risk factors in patients receiving OPAT at home.
This retrospective study included hospitalized patients 15 years and older who were discharged on intravenous antimicrobial therapy OPAT at home between January 2018 and December 2019. Patients receiving antimicrobials at a skilled nursing facility, long-term acute care, or dialysis center, and those who began OPAT at home directly from the outpatient setting were excluded. The primary outcome of this study was all-cause 30-day readmission rate. Secondary outcomes included 90-day readmission rate, rates of complications related to OPAT, emergency department visits during OPAT, and predictors of all-cause 30-day readmission through a logistic regression analysis.
Two hundred individual patients were included in the analysis; 60% were male and the mean age was 49 years. The most common indications for OPAT at home were bone and joint infection (52%) and bacteremia (26%). Forty patients (20%) experienced an unplanned, all-cause 30-day readmission, with a total of 48 readmission events. Of the 40 patients who were readmitted within 30 days, 20 (50%) were due to non-OPAT related reasons. Sixty patients (30%) experienced an OPAT-related complication, and chronic kidney disease was found to be an independent predictor of readmission (OR: 2.8, 95% CI: 1.0-7.6).
Patients receiving OPAT at home are at increased risk for early hospital readmission, but it is often due to reasons not associated with OPAT. Patients with chronic kidney disease beginning OPAT at home should be closely monitored after discharge.
门诊胃肠外抗菌治疗（OPAT）在必要时对患者和医疗系统有益，可缩短住院时间、节省成本并提高患者满意度。
本研究旨在确定接受家庭OPAT治疗患者的再入院率及相关危险因素。
这项回顾性研究纳入了2018年1月至2019年12月期间15岁及以上因静脉抗菌治疗而在家接受OPAT治疗出院的住院患者。排除在专业护理机构、长期急性护理机构或透析中心接受抗菌治疗的患者，以及直接从门诊环境在家中开始接受OPAT治疗的患者。本研究的主要结局是全因30天再入院率。次要结局包括90天再入院率、与OPAT相关的并发症发生率、OPAT期间的急诊科就诊次数，以及通过逻辑回归分析得出的全因30天再入院的预测因素。
200名患者纳入分析；60%为男性，平均年龄为49岁。在家中进行OPAT治疗最常见的指征是骨和关节感染（52%）和菌血症（26%）。40名患者（20%）经历了计划外的全因30天再入院，共发生48次再入院事件。在30天内再次入院的40名患者中，20名（50%）是由于与OPAT无关的原因。60名患者（30%）出现了与OPAT相关的并发症，发现慢性肾脏病是再入院的独立预测因素（比值比：2.8，95%置信区间：1.0 - 7.6）。
在家接受OPAT治疗的患者早期再次入院风险增加，但通常是由于与OPAT无关的原因。在家中开始接受OPAT治疗的慢性肾脏病患者出院后应密切监测。
