Outcome of Liver Abscess Managed With Outpatient Parenteral Antimicrobial Therapy (OPAT)

Abstract

Introduction: This study evaluates the management of liver abscess on an outpatient basis. The cost of a day of hospitalization is approximately $1600 - $2000 according to Becker's Hospital Review 2010 report. Methods: This is a retrospective study in which we examined the database of patients managed in the OPAT for Liver abscess from 2010 to 2013. There were a total of 11 patients treated for Liver abscess. Data was collected on demographic information, presenting symptoms, microbiology results, antibiotic choice and duration, mortality and readmissions and length of stay. Data was also collected on whether the abscess was drained, evidence of cure per follow up imaging. Results: The majority of affected patient were male 72.7% (8/11). The average age of patients was 59 years old. The average Length of stay was 12.4 days ranging from 6 days to 18 days. The average duration of intravenous antibiotics was 4.7 weeks. Most cases were poly-microbial (6/11) (54.5%), 4/11 (36.4%) were mono-microbial and 1 patient had no positive microbiological studies. There were 6/11 (54.5%) patients that underwent percutaneous drainage of the abscess while 5/11 (45.5%) did not. There were 7/11 (63.6%) patients who had radiographic evidence of cure/resolution, 4/11 (36.4%) had evidence of improvement but not complete resolution at the time of the follow up study. One patient lacked any follow up data therefore mortality could not be assessed. Mortality at 30, 60 and 180 days was 0. Mortality at one year was 2/11 (18.2%). 3 patients had no follow up at one year to assess mortality. Readmissions at 30 days was 3/11 (27.3%), 60 days was 4/11 (36.4%), 180 days was 3/11 (27.3%), 1 year was 3/11 (27.3%). Readmission was only related to liver abscess on one occasion. Conclusion: Outpatient antimicrobial therapy is a safe and cost effective option for the management of Liver abscesses. Using the values from the Becker's hospital review and the average length of stay in this study of 4.7 weeks we can estimate a potential cost of about $ 56,000 to $70,000 that is avoided by treating the patient with Outpatient Antimicrobial Therapy (OPAT).