774. A New Outpatient Parenteral Antimicrobial Therapy (OPAT) Management Program Reduces Excess Antimicrobial Days of Therapy and Expedites Timely Central Line Removal

Abstract

BackgroundPatients discharged on parenteral antimicrobials often require in-person follow-up to determine antimicrobial discontinuation and coordination of central line (CL) removal at the end of therapy. Without close attention to timing of follow-up, antimicrobial courses may be extended beyond a planned end date until scheduled follow-up, leading to excess antimicrobial days of therapy (DOT) and CL retention. Excess DOT can result in increased cost of medication and CL supplies, antimicrobial exposure, and risk of CL-associated bloodstream infections or thrombosis. We sought to assess the impact of the University of Virginia (UVA) OPAT program on excess antimicrobial DOT and excess CL days.MethodsThis was a retrospective chart review of patients enrolled in the OPAT program at UVA between August 2018 and April 2019. The UVA OPAT program was started in August 2018. Quality improvement (QI) practice changes were implemented in February 2019 for improving follow-up and stopping antimicrobials at the projected end date. Patients were therefore divided into 2 cohorts – August through January 2018 and February through April 2019. Data collected included projected end date of therapy (EOT), actual EOT, actual removal date of CL, and follow-up date. Excess antimicrobial DOT and excess CL days were calculated by the difference in projected vs. actual dates. For continuous data, Student t-test was used.Results248 patients enrolled in OPAT from August 2018 through April 2019. After implementation of QI efforts, mean time from projected EOT to follow-up appointment decreased from 10.0 days to 4.3 days for those with appointments after projected EOT. Mean excess antimicrobial DOT decreased from 2.8 ± 4.53 SD days to 1.6 ± 2.75 SD days (P = 0.026), and mean excess CL days decreased from 3.2 ± 4.63 SD days to 2.0 ± 2.89 SD days (P = 0.035).ConclusionThe involvement of an OPAT program with close attention to outpatient follow-up and cessation of antimicrobials decreased the excess antimicrobial DOT and CL days and reduced variability in care. Reduction in antimicrobial overuse and CL overuse is expected to reduce cost and decrease the risk of medication- and CL-related collateral damage.Disclosures All authors: No reported disclosures.