674. Successful Management of ESBL Infections in Physician Outpatient Infusion Centers (POICs)

Abstract

Abstract Background Infections with extended-spectrum β-lactamase (ESBL)-producing pathogens present treatment challenges with higher costs of care. Hospitalized patients (pts) with ESBL infections often require outpatient antimicrobial therapy (OPAT) following discharge. An Infectious Disease (ID) physician can facilitate optimal management in both the inpatient and outpatient setting, particularly when a POIC is an option. The increase of ESBL incidence led us to evaluate management and outcomes of genitourinary (GU) and intra-abdominal infections (IAI), the top two ESBL diagnoses treated in POICs. Methods Records were queried for pts hospitalized with ESBL infection and discharged to a POIC between 2019 and 2020. Primary outcome was completion of OPAT. Non-successful completion was defined as premature discontinuation of OPAT including hospital readmission. Adverse events (AEs) and re-treatment within 30 days were captured. Results A total of 112 pts (mean age: 59±17 years, 50% female) from 14 POICs were identified (93 GU, 19 IAI). Of these, 51% had their first ESBL infection and 52% were community-acquired prior to hospitalization. A total of 38% presented with concomitant bacteremia. ESBL E. coli was the predominant Gram-negative pathogen in both infection types (Table 1). Mean hospital LOS was 6±4 days (5±2 days GU, 11±6 days IAI) followed by 13±9 days of OPAT (12±7 days GU, 16±11 days IAI). Carbapenems were most frequently used as treatment (89% ertapenem, 7% meropenem). Overall, 106 pts (95%) successfully completed OPAT. Six pts (5%) discontinued due to hospital readmission. AEs were reported in 15 pts (13%), the majority of which were mild. Re-treatment in the POIC within 30 days post OPAT completion occurred in 6 GU pts. None were lost to follow-up. Table 1 summarizes primary outcome by clinical characteristics. Both GU and IAI pts had 95% successful OPAT completion. Table 1.Successful and non-successful completion of OPAT in patients with ESBL infections Conclusion Outpatient treatment of ESBL infections in POICs post-hospitalization showed high completion rates with low occurrence of readmissions and re-treatments. Consistent with a rise in ESBL infections, our incidence of community-acquired ESBL infections prior to hospitalization were high at 52%. Once ESBL infections were identified in the hospital, the ID physicians with a POIC rapidly facilitated discharge to OPAT. Disclosures Ramesh V. Nathan, MD, FIDSA, Eli Lilly & Co.: Grant/Research Support Brian S. Metzger, MD, MPH, AbbVie: Advisor/Consultant|Cumberland: Advisor/Consultant Lucinda J. Van Anglen, PharmD, Merck & Co.: Grant/Research Support|Paratek: Grant/Research Support.