Outpatient Parenteral Antimicrobial Therapy and Antimicrobial Stewardship Implementation of a Structured Approach to Improve Patient Outcomes

Objectives: Outpatient parenteral antimicrobial therapy (OPAT) is frequently used upon hospital discharge but often without infectious diseases (ID) or Antimicrobial Stewardship Programs (ASP) oversight. The purpose of this study was to evaluate the transition of care process for OPAT and identify the role of the ASP. Second, clinical and safety outcomes associated with the use of ertapenem for OPAT were evaluated. Methods: This is a single-center, observational study of adult patients hospitalized from January 1, 2011, through December 31, 2011, who were discharged on ertapenem +/- additional antimicrobials. Population characteristics and clinical outcomes are outlined using descriptive statistics. Results: There were 100 patients who met inclusion criteria. Clinical cure was achieved in 79% of patients. Median duration of ertapenem therapy was 21 (14-42) days. Among patients who had an ID consult, clinical cure was achieved in 59% compared with 41% of patients who did not have an ID consult (P = 1.000). The reasons for clinical failure included 15 (71%) lack of source control, 4 (19%) required an additional antibiotic, and 2 (10%) antibiotic-related adverse event. Sixteen patients could have potentially received an oral antibiotic instead of OPAT. Fourteen patients required readmission within 30 days. Conclusions: The ASPs should assume a role in the management of OPAT patients and transition of care from inpatient to outpatient. We recommend a structured approach, including the implementation of a standard order set for patients discharged on OPAT.