Register for citation alerts

Vascular Access Conversation - IVUPDATE Podcast from IVTEAM

"Discharge to an SARC is strongly associated with increased risks of readmission for OPAT-related complications and CRBSI. Loss to follow-up with the infectious diseases service is strongly associated with increased risk of readmission and CRBSI" Kaul et al (2022).
Risk factors associated with OPAT complications

Abstract:

Objective: To characterize factors associated with increased risk of outpatient parenteral antimicrobial therapy (OPAT) complication.

Design: Retrospective cohort study.

Setting: Four hospitals within NYU Langone Health (NYULH).

Patients: All patients aged ≥18 years with OPAT episodes who were admitted to an acute-care facility at NYULH between January 1, 2017, and December 31, 2020, who had an infectious diseases consultation during admission.

Results: Overall, 8.45% of OPAT patients suffered a vascular complication and 6.04% suffered an antimicrobial complication. Among these patients, 19.95% had a 30-day readmission and 3.35% had OPAT-related readmission. Also, 1.58% of patients developed a catheter-related bloodstream infection (CRBSI). After adjusting for key confounders, we found that patients discharged to a subacute rehabilitation center (SARC) were more likely to develop a CRBSI (odds ratio , 4.75; P = .005) and to be readmitted for OPAT complications (OR, 2.89; P = .002). Loss to follow-up with the infectious diseases service was associated with increased risks of CRBSI (OR, 3.78; P = .007) and 30-day readmission (OR, 2.59; P < .001).

Conclusions: Discharge to an SARC is strongly associated with increased risks of readmission for OPAT-related complications and CRBSI. Loss to follow-up with the infectious diseases service is strongly associated with increased risk of readmission and CRBSI. CRBSI prevention during SARC admission is a critically needed public health intervention. Further work must be done for patients undergoing OPAT to improve their follow-up retention with the infectious diseases service.

Reference:

Kaul CM, Haller M, Yang J, Solomon S, Wang Y, Wu R, Meng Y, Pitts RA, Phillips MS. Assessment of risk factors associated with outpatient parenteral antimicrobial therapy (OPAT) complications: A retrospective cohort study. Antimicrob Steward Healthc Epidemiol. 2022 Nov 11;2(1):e183. doi: 10.1017/ash.2022.313. PMID: 36406163; PMCID: PMC9672913.