Outpatient Antimicrobial Therapy Program Research Articles

124. Implementation of IV Push Antibiotics for Outpatients During a National Fluid Shortage Following Hurricane Maria

BackgroundPrior to the introduction of intravenous (IV) drip infusion, most IV drugs were delivered in a single bolus. However, with the advent of new agents, IV drip infusions became the standard for all medication delivery. In September 2017, Hurricane Maria made landfall in Puerto Rico and took a devastating toll. As Puerto Rico is the largest supplier of IV fluid bags, this lead to a worldwide fluid bag shortage. The outpatient antimicrobial therapy program (OPAT) was significantly impacted by the fluid shortage and this required effective stewardship at the Parkland Health and Hospital System in order to serve a largely uninsured and under-insured patient population. MethodsParkland pharmacists evaluated all self-administered antimicrobials for viability of administration as an IV single bolus push (IV-push) instead of a mini-bag infusion (IV-drip infusion). These medications were transitioned to IV-push for patient care. Data was gathered on patient demographics, 30-day readmission rates, mortality, discharge teaching satisfaction, patient satisfaction, and cost evaluation. Results113 treatment courses were self-administered using the IV-push method and were compared to 102 self-administered courses using the IV drip infusion method, over the same time course. Individuals using IV-push had a statistically significant decrease in hospital length of stay as compared to those using IV-drip infusion. The 30-day readmission rate, emergency department visits, and mortality were similar between groups. Patient satisfaction was greater with IV-push (96% preferring). The shift to IV-push via the S-OPAT program saved 504 liters of normal saline, which along with a reduction in supplies and drug costs, resulted in an additional savings of &43,652 over a 6-month period.ConclusionThe abrupt IV fluid shortage following a natural disaster challenged clinicians to think differently about standard practices. This led to implementation of a high value care model that is sustainable without affecting safety, efficacy, or efficiency. Given the cost savings, increased patient satisfaction, and equal clinical outcomes, the IV push model is not only a viable alternative initiated during a crisis; it is preferable in many standard situations. Disclosures All Authors: No reported disclosures

769. Comparison of Vancomycin Continuous and Intermittent Infusion Dosing Strategies Among Patients in an Outpatient Antimicrobial Therapy Program

BackgroundVancomycin may be administered via intermittent infusion (I-I) or continuous infusion (C-I). C-I vancomycin has advantages including the potential for less nephrotoxicity; however, available data are inconsistent and varies based on inpatient and outpatient settings. Thus, the primary objective of this study was to compare rates of nephrotoxicity in patients who received C-I or I-I vancomycin in an outpatient parenteral antimicrobial therapy (OPAT) program. Secondary objectives included time to onset of nephrotoxicity and clinical failure.MethodsThis was a single-center, propensity score-matched, retrospective cohort study of patients who received C-I or I-I vancomycin for at least one week in the OPAT program between October 1, 2017 and March 31, 2019. Exclusion criteria included patients lost to follow-up, age less than 18 years old, and those requiring renal replacement therapy. Nephrotoxicity was defined as a serum creatinine (Scr) increase of >0.5 mg/dL or >50% from baseline for two consecutive measurements. Clinical failure was defined as unplanned readmission, extension of planned therapy, or change in antibiotic therapy.ResultsThree hundred patients were identified who received C-I or I-I vancomycin. After propensity score matching and exclusion criteria were applied, 74 patients were included in each cohort. Demographic information was similar between cohorts including baseline Scr, age, gender, comorbidities, concurrent nephrotoxins, indication, and vancomycin duration. C-I was associated with a 3.22-fold decrease in nephrotoxicity risk when compared with I-I [C-I: 6.8% vs. I-I 18.9%; OR (95% CI): 3.22 (1.10–9.46), P =0.027]. C-I was associated with a significantly slower onset to nephrotoxicity compared with I-I (P = 0.035; Figure 1). A significant difference in clinical failure was not observed between C-I and I-I (10/74, 13.7% vs. 17/74, 23.0%; P = 0.147).ConclusionC-I vancomycin was associated with a lower nephrotoxicity risk and slower onset to nephrotoxicity, but no difference in clinical failure rates when compared with I-I. Disclosures All authors: No reported disclosures.

Antibiotic Clinic: Two Years' Experience in Outpatient Parenteral Antimicrobial Therapy in a Portuguese Hospital.

Outpatient antimicrobial therapy programs have been in place for more than four decades. They provide safe and effective treatment for a selected group of patients while reducing costs. In Europe in general, and in Portugal in particular, these programsare still a relatively new phenomenon. The aim of this study is to describe our center's two years' experience with such a program(Antibiotic Clinic). The cohort of treatments administered by the Antibiotic Clinic in its first two years of existence (September 12th2016 to September 11th 2018) was analyzed and data pertaining to patients, infections, infectious agents, antimicrobials and outcomes(infection resolution, adverse events and death) were characterized. The Antibiotic Clinic treated 231 patients in 250 episodes, providing a total of 2357 days of antibiotic treatment. The urinarytract was the most common site (39.2%) and Enterobacteriaceae the most common agents (63.7% of isolates). Infections were resolved in 90.8% of treatments (95.6% of patients), adverse events were few (1.2%) and direct mortality was not found. The dropoutrate was 1.6%. Infection resolution and adverse event rates were comparable to other centers. High treatment and low dropout rates pointto high physician and patient acceptance. Our experience with this program suggests it is a safe and effective alternative to inpatient admission. This is in line withcurrent literature which suggests efforts should be made to expand this treatment modality.

1931. Health-Related Social Vulnerabilities in a Pediatric Outpatient Antimicrobial Therapy (OPAT) Program

BackgroundSerious pediatric infections are treated safely with outpatient parenteral or prolonged oral antibiotic therapy (OPAT). The OPAT delivery system can be complex with outcomes complicated by social vulnerabilities in the lives of children on OPAT. Our goal was to better understand the psycho-social challenges pediatric families face undergoing OPAT.MethodsCaregivers of patients discharged on parenteral or prolonged oral antibiotics and referred to Doernbecher Children’s Hospital OPAT program between July 1, 2017 and December 31, 2017 were eligible for enrollment. We assessed health-related social vulnerabilities using a pre-discharge survey of pediatric caregivers. Child-specific medical information was collected by EMR review. Descriptive statistics were used to characterize social challenges.ResultsTwenty-six caregivers completed the survey. Mean patient age was 7.7 years. Infections included osteomyelitis (31%), endocarditis or infectious thrombophlebitis (19%), brain abscess or meningitis (15%), complicated pneumonia (12%), device-related infections (12%), or other (12%). Combined, patients spent 1,150 days on OPAT (390 parenteral; 760 prolonged oral antibiotic days). Of the social vulnerabilities endorsed, economic hardship featured prominently with 31% of caregivers having difficulty paying for food, housing or utilities and 12% having problems with appliances working at home. Among the caregivers, 23% reported inadequate social support, 42% reported psychological problems (31% anxiety; 19% depression), 15% reported involvement with child protective services, and 19% reported other legal concerns. 27% had difficulty getting time off work and 31% requested extra help with coordination of healthcare services. 58% of caregivers had a high school degree or less.ConclusionWe identified a large number of social vulnerabilities that likely impact pediatric OPAT care after discharge. Identifying social vulnerabilities for pediatric OPAT patients prior to discharge, such as health literacy or barriers to return visits, could better enable treatment customization or prompt care coordination that better supports pediatric OPAT patients.Disclosures All authors: No reported disclosures.

Outcomes Associated With Outpatient Antimicrobial Therapy Program

Outcomes Associated With Outpatient Antimicrobial Therapy Program