1854. Effective Antimicrobial Stewardship for Outpatient Parenteral Antimicrobial Therapy (OPAT): Nationwide Experience in Infectious Disease Physician Infusion Centers

Abstract

BackgroundAntimicrobial stewardship (AS) is an important factor in combatting antimicrobial resistance and optimizing clinical outcomes, especially in the outpatient setting. With no AS guidelines in the United States for OPAT, we developed an antimicrobial stewardship program (ASP) for OPAT in 2016, which was piloted and applied to Infectious Disease practices and infusion centers. The program was expanded and assessed nationally in additional centers in 2017, adding appropriateness of empiric therapy (tx), supervision of first doses of antimicrobials, compliance with tx regimen, appropriate tx changes and staff education.MethodsAn assessment instrument was developed through literature review, expert opinion and validated with a logistic model. Patients receiving OPAT in 2017 were randomly selected and retrospectively reviewed based on annual patient volume from 14 OPAT practices. The table shows the ASP assessment tool consisting of 7 Core Elements (CE) scored at 10 points each and 6 Other Elements (OE) scored at 5 points each. Logistic regression was used to validate the relationship between the composite outcome elements and all other elements (aOR = 0.929, P = 0.0005, c = 0.704). Appropriateness of empiric tx and tx length was evaluated using evidence-based guidelines. Each patient OPAT course was assessed and scored for compliance to required elements with an achievable score per patient of 100 points (100%). IV to PO conversion was evaluated secondarily. Descriptive statistics were used.ResultsA total of 200 OPAT courses were scored for compliance to each ASP element as noted in the table. The overall compliance rate for CE and OE was 93.0% and 93.3%, respectively. All CEs were ≥90% compliant, except for duration of tx. This exceeded guidelines in 15% of patient courses due to severe disease presentation. For the OEs, all achieved ≥90% compliance except laboratories performed as ordered. Early conversion from IV to PO resulted in a reduction of 240 IV days for 1.2 days per patient.ConclusionWe successfully developed an OPAT ASP with national expansion. Opportunities were identified for improvement in laboratory processes and enhanced evaluation regarding tx durations. This validated ASP provides a valuable tool for OPAT, incorporating key elements for stewardship success. Disclosures R. V. Nathan, Merck & Co.: Scientific Advisor and Speaker’s Bureau, Consulting fee and Speaker honorarium. The Medicines Company: Speaker’s Bureau, Speaker honorarium. Allergan: Speaker’s Bureau, Speaker honorarium. R. L. Hengel, Merck & Co.: Scientific Advisor, Consulting fee. K. A. Couch, Allergan: Speaker’s Bureau, Speaker honorarium. Merck: Speaker’s Bureau, Speaker honorarium. Melinta: Speaker’s Bureau, Speaker honorarium. L. J. Van Anglen, Merck & Co.: Grant Investigator, Research grant.