Outpatient Intravenous Therapy Research Articles

Effects of Music Therapy on Patients with Cancer Receiving Outpatient Treatment

Patients with cancer often experience anxiety when waiting for diagnostic test results, before receiving treatment, or when informed of a recurrence. Therefore, appropriate interventions are required at each of these stages. This study determines the effects of music therapy with preferred music on anxiety, blood pressure, pulse, and the satisfaction of patients with cancer when receiving outpatient intravenous therapy in a long-term care facility. This quasi-experimental non-equivalent control-group and non-synchronized study was conducted in the outpatient injection room of a long-term care facility in South Korea. This study included 57 patients (divided into experimental and control groups) with female reproductive system/breast or digestive system cancer who received short-term intravenous vitamin C on an outpatient basis. The participants chose from a music selection table for each genre, which was based on the prior research, under the supervision of a professor experienced in music therapy. The participants selected 20 songs to listen to for 1 h while receiving intravenous therapy. The participants were surveyed for state anxiety and satisfaction to confirm the effects of music therapy, and their systolic and diastolic blood pressure and pulse were measured. The state anxiety (U=282, p=.046) and satisfaction (U=262, p=.016) scores of the experimental and control groups revealed significant differences. There were no significant differences in systolic blood pressure (U=311, p=.13), diastolic blood pressure (t=1.88, p=.065), and pulse (t=-0.5, p=.61) between the experimental and control groups. Music therapy is an effective intervention for reducing anxiety and improving satisfaction in patients with cancer when receiving short-term outpatient treatment. However, to generalize these results, a larger sample size of participants is needed with similar types of cancer.

Evaluating the Impact of Interventions and Improvements in Outpatient Intravenous Infusion Therapy at a Hospital in China: A Comprehensive Analysis of Prescription Patterns and Safety Measures.

The excessive use of intravenous infusion in China was once a serious problem, but in recent years, attention has been paid to the phenomenon, and the government has implemented several policies to solve the problem, which has been gradually improved. This study focuses on evaluating the impact of ongoing interventions and improvements in outpatient intravenous infusion therapy. From January 2016 to December 2022, we conducted a study to gather annual data on intravenous infusion prescriptions. A data questionnaire, encompassing information on departments, clinical diagnosis, and infusion drugs, was developed for this purpose. We analyzed the changing trends of Top 10 clinical departments with higher intravenous infusion usage rates and Top 10 drugs used. We also evaluated the compliance of intravenous infusion prescriptions with management regulations and drug instructions, for further intervention in the future. The analysis of intravenous infusion prescription rates revealed a gradual decrease from 10.89% to 5.63%. This reduction was statistically significant (P < 0.05). High levels of intravenous infusion use were consistently observed in emergency surgery and emergency medicine. Commonly administered drugs via infusion included antibacterial drugs, tumor medications, proton pump inhibitors, and injections of traditional Chinese medicine. Inappropriate prescriptions are often characterized by issues related to drug dosage, usage, indication, and selection. Trend analysis of unreasonable types revealed significant improvements in "Diagnosis incomplete/unwritten", "Solvent selection", "Dosing frequency", and "Treatment without indication" (P < 0.05). The findings of this study indicate a gradual improvement in the situation regarding intravenous infusion. However, there are still prevalent instances of unreasonable practices that need to be addressed.

Physician Financial Incentives for Use of Outpatient Intravenous Antimicrobial Therapy: An Interrupted Time Series Analysis.

In 2011, policymakers in British Columbia introduced a fee-for-service payment to incentivize infectious diseases physicians to supervise outpatient parenteral antimicrobial therapy (OPAT). Whether this policy increased use of OPAT remains uncertain. We conducted a retrospective cohort study using population-based administrative data over a 14-year period (2004-2018). We focused on infections that required intravenous antimicrobials for ≥10 days (eg, osteomyelitis, joint infection, endocarditis) and used the monthly proportion of index hospitalizations with a length of stay shorter than the guideline-recommended "usual duration of intravenous antimicrobials" (LOS < UDIVA) as a surrogate for population-level OPAT use. We used interrupted time series analysis to determine whether policy introduction increased the proportion of hospitalizations with LOS < UDIVA. We identified 18 513 eligible hospitalizations. In the pre-policy period, 82.3% of hospitalizations exhibited LOS < UDIVA. Introduction of the incentive was not associated with a change in the proportion of hospitalizations with LOS < UDIVA, suggesting that the policy intervention did not increase OPAT use (step change, -0.06%; 95% confidence interval [CI], -2.69% to 2.58%; P = .97 and slope change, -0.001% per month; 95% CI, -.056% to .055%; P = .98). The introduction of a financial incentive for physicians did not appear to increase OPAT use. Policymakers should consider modifying the incentive design or addressing organizational barriers to expanded OPAT use.

The Mortality Benefit of Milrinone as a Continuous Outpatient Intravenous Inotrope Therapy in Advanced Heart Failure: A Systemic Review and Meta-Analysis.

The Mortality Benefit of Milrinone as a Continuous Outpatient Intravenous Inotrope Therapy in Advanced Heart Failure: A Systemic Review and Meta-Analysis.

1020. The Impact of COVID-19 on Outpatient Intravenous Antimicrobial Therapy (OPAT) at an Academic Medical Center

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic dramatically affected the delivery of healthcare. Patients discharged on outpatient parenteral antibiotic therapy (OPAT) require clinic follow-up and laboratory monitoring which is a logistical challenge to standardize across discharge locations. We sought to investigate how COVID-19 impacted patients discharged with OPAT at an academic medical center. Primary objectives included 30-day readmission rates and ID clinic follow-up before and during COVID-19. Secondary outcomes included whether suspected infection type, antimicrobial selection and discharge location differed between the two cohorts. Baseline Patient Characteristics &amp; Outcomes between pre-COVID-19 and COVID-19 cohorts Methods Patients discharged on OPAT were evaluated in two 3-month cohorts from Oct-Dec 2019 (pre-COVID-19) and compared to Oct-Dec 2020 (COVID)-19. Demographics, infection type, discharge location, therapy characteristics, and outcomes were compared retrospectively (Fig 1). Statistical analysis was performed using Chi-square and Wilcoxon rank-Sum test with p&amp;lt; 0.05 considered statistically significant. Suspected Infectious Source among the two cohorts Results A total of 316 pre-COVID patients were discharged with OPAT compared to 263 COVID-19 patients. Table 1 shows the comparison of OPAT characteristics between 2019 and 2020. There were significantly more patients discharged home and fewer patients discharged to facilities in COVID-19 group(p=0.001 and p=0.011, respectively). LOS, ID clinic follow-up, and 30-day readmission did not differ between groups. Reasons for readmission were similar (Fig 1). Antimicrobial prescribing was generally similar except for more vancomycin prescribed in the COVID-19 group (12.5% versus 7.3%, p=0.033). Suspected source of infection did not differ between groups (Fig 2), nor did isolation of pseudomonas, MRSA, or drug resistant organisms (Table 2). Conclusion Sources of infection and antimicrobial classes were generally similar despite decrease in elective procedures during a COVID-19 related winter surge. Rates of readmission and clinic follow did not differ, however, patients discharged with OPAT post-COVID were more likely to go home versus a facility. Further analysis of this difference may help determine best practices to facilitate improved monitoring and clinic follow-up among OPAT patients. Disclosures All Authors: No reported disclosures.

Understanding the relationship between patient characteristics and complication in veterans discharged on parenteral antibiotic therapy.

Many facilities utilize outpatient parenteral intravenous (IV) antimicrobial therapy (OPAT) to reduce cost, length of stay, and risk of nosocomial infections. The objective of this study was to analyze patient demographics, substance use, mental and physical health diagnoses, and social determinants of health to seek relationships with complications for veterans discharged from the Zablocki Veterans Affairs Medical Center (ZVAMC) on OPAT. This study was a retrospective chart review of veterans who completed OPAT between the years of 2013 and 2017at the ZVAMC in Milwaukee, Wisconsin. Prior to discharge, patients were screened by the OPAT team for eligibility; patients were followed after discharge by pharmacy, home care, and providers. OPAT complication was defined as antibiotic change/dose adjustment, IV catheter complication, or an additional hospital visit secondary to current infection or therapy. 294 veterans' charts were reviewed. Of these patients, 106 (36.05%) had a complication. Tobacco use was the only factor significantly associated with OPAT complication. Cohabitation, employment status, mental health diagnosis and alcohol use were not associated with OPAT failure; however, tobacco use merits further review for use in OPAT screening protocols.

The management of tubo-ovarian abscess - A retrospective analysis of a centre offering outpatient intravenous antibiotic therapy

Background Tubo-ovarian abscess (TOA) carries long-term sequale in women of reproductive age. Consensus of the optimal treatment of tubo-ovarian abscess remains lacking. The aims of this study are to identify risk factors predicting the need for early drainage and compare clinical outcomes of current management practices of TOA. Methods From 2015 to 2019, a retrospective cohort study of 92 women admitted to a tertiary centre for gynaecological surgery was performed. Patients with diagnosed TOA were classified into two groups: treatment with antibiotics only, and those receiving additional drainage. Primary outcomes included length of hospital stay (LoS), length of antibiotic treatment (LoA) and need for re-intervention. Results In this study, 52 women (56.5%) were successfully treated with first line intravenous antibiotics; 40 (43.5%) received surgical drainage. Significant predictors for successful medical treatment only include age &lt; 35 (OR: 0.89, 95% CI: 0.82-0.97) and abscess size &lt; 6cm (OR: 0.17, 95% CI: 0.04-0.64), using multivariate analysis. Pyrexia ≥ 38°C predicted a need for drainage (OR: 3.82, 95% CI: 1.01-8.12). Patients who received additional drainage had significantly longer LoA, LoS and higher rates of re-intervention. Within this group, drainage within 72 hours of admission resulted in a trend towards shorter LoA and LoS than drainage after 72 hours, albeit not statistically significant. Conclusions Parameters include age &gt; 35 years, pyrexia ≥ 38°C and a TOA size &gt; 6cm may independently predict the need for drainage of TOA. Early identification of these patients is imperative for timely surgical intervention to avoid prolonged hospitalisation, antibiotic usage, and patient morbidity. More work is required to identify whether early drainage may reduce length of hospital stay and antibiotic treatment, including identifying certain patient groups who most likely to benefit from outpatient antibiotic intravenous therapy.

597. The Impact of COVID-19 on Outpatient Intravenous Antimicrobial Therapy (OPAT) in Physician Office Infusion Centers (POICs)

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic dramatically affected the provision of healthcare in the U.S. with sharp declines in routine and elective healthcare services. Outpatient clinic visits declined nearly 60% in the early pandemic. We investigated how COVID-19 impacted the provision of OPAT at various Infectious Disease (ID) POICs nationwide. MethodsPatient (pt) records were evaluated from Jan 2019 – July 2019 and compared to Jan 2020 – July 2020. Data collected included new OPAT pts, demographics, infection type, location prior to OPAT and therapy characteristics. Statistical analysis was performed using Chi-square test with p< 0.05 considered statistically significant. ResultsFourteen POICs reported data with a total of 2410 new OPAT pts in 2019 and 1807 in 2020, representing a decrease of 25%. Table 1 shows the comparison of OPAT characteristics between 2019 and 2020. Mean age and gender were similar, but there was a significantly higher percentage of pts ≥65 years treated in 2020 (43% vs. 36%, p< 0.001). Infection type and location prior to OPAT were consistent between 2019 and 2020. Primary antimicrobial use was comparable with the exception of cefepime, which showed a greater use in 2020 (14% vs. 11%, p=0.006). OPAT management differed significantly from 2019 to 2020 with fewer pts completing therapy as prescribed in 2020 (85.9% vs. 88.3%, p=0.021), driven largely by more early discontinuations and switches to oral therapy. Other reasons for those not completing therapy were also significant and due primarily to transfer of care to other settings, most commonly the home (1.9% vs. 2.9%, p=0.029). Overall length of therapy was comparable. Table 1. Comparison of OPAT in 2019 (Pre-COVID) and 2020 (Post-COVID) ConclusionOPAT provided through ID POICs experienced a substantial decrease in pts treated during the first half of 2020 compared to 2019. This was expected with the decline in healthcare services, especially elective procedures. Most pt and treatment characteristics were comparable between years, but interestingly, more elderly received OPAT during the pandemic and fewer completed therapy as planned. Further analysis of these differences can help determine effects of the pandemic on overall health outcomes in the OPAT population. Disclosures Lucinda J. Van Anglen, PharmD, Merck & Co. (Research Grant or Support)

Role of infectious diseases pharmacists in outpatient intravenous and complex oral antimicrobial therapy: Society of Infectious Diseases Pharmacists insights

AbstractOutpatient parenteral antimicrobial therapy (OPAT) is a well‐established mechanism to facilitate patient discharge, lower inpatient admission cost, and decrease the risk of health care–acquired infections. Although there are numerous benefits to patients and health care institutions, OPAT is complex and not without risks. Patients may be discharged on long courses of oral antimicrobials, known as complex outpatient antimicrobial therapy (COpAT), which also requires careful monitoring and oversight. This, coupled with the need for antimicrobial stewardship across the continuum of care, positions pharmacists with infectious diseases (ID) training as crucial leaders in the field of OPAT. The development, implementation, and maintenance of these services requires the careful attention of health care personnel in discharge antimicrobial selection, continuity of care at key care transitions, implementation of optimal care bundles, provision of thorough patient education throughout the OPAT process, coordination with a multidisciplinary team including home infusion and nursing, and monitoring of program metrics to determine successes and opportunities for improvement. Ongoing support for optimal delivery of patient care will be required as OPAT practice, and health care delivery at large, continues to evolve. This involves continued advocacy for collaborative practice development, optimizing payment for nondispensatory OPAT services, and integration of effective telehealth programs. This article summarizes the need for practice expansion of ID pharmacist specialists in OPAT/COpAT management across the care continuum and best practices for establishment of these services.

Abstract 15299: Outpatient Intravenous Lasix Trial in Reducing Hospitalization for Acute Decompensated Heart Failure (OUTLAST)

Introduction: Hospitalization for acute decompensated heart failure (ADHF) remains a major source of morbidity and mortality. While previous studies have shown outpatient intravenous (IV) diuretic therapy to be safe and cost-effective, there have been no randomized controlled trials to evaluate the utilization of continued outpatient IV furosemide diuretic maintenance treatment in patients with HF following hospitalization for ADHF. Hypothesis: We hypothesized that 30-day hospital readmission from ADHF would be lower with routine, standardized outpatient IV diuretic treatment along with a comprehensive HF care approach vs standard treatment. Methods: In a single center, prospective, randomized, double-blind study, 100 patients were randomized to receive standard of care (Group 1), IV placebo infusion (Group 2), or IV furosemide infusion (Group 3) over 3 hours, biweekly for a one-month period following hospitalization for ADHF. Patients in Groups 2 and 3 also received a comprehensive HF care protocol including bi-weekly clinic visits for dose-adjusted IV-diuretics, medication adjustment, laboratory, weight, and blood pressure-monitoring, and education during infusion visits. Echocardiography, Kansas City Cardiomyopathy Questionnaire (KCCQ) and depression questionnaires were performed at baseline and 30-day follow-up. The primary outcome was 30-day re-hospitalization for ADHF. Results: Overall, a total of 94 patients were included in the study (mean age 64 years, 56% males, 69% African American, 70% HF reduced ejection fraction). There were a total of 14 (15%) readmissions for ADHF at 30 days, 6 (17.1%) in Group 1, 7 (22.6%) in Group 2, and 1 (3.7%) in Group 3 (overall p=0.11; p=0.037 comparing Group 2 and Group 3). Patients receiving IV furosemide infusion experienced significantly greater urine output and weight loss compared to those receiving placebo without any significant increase creatinine and no significant between group differences in echocardiography parameters, KCCQ or depression scores. Conclusions: The use of a standardized protocol of outpatient IV furosemide infusion for a one-month period following hospitalization for ADHF was found to be safe and efficacious in reducing 30-day re-hospitalization.

Oritavancin for the treatment of complicated gram-positive infection in persons who inject drugs

BackgroundTreatment of complicated infections in persons who inject drugs (PWID) and patients experiencing homelessness poses a unique challenge to clinicians. Long-acting lipoglycopeptide antibiotics, such as oritavancin, may facilitate extended courses of outpatient intravenous therapy while avoiding the need for central lines, improving compliance and thus increasing the chance of clinical cure.MethodsRetrospective chart review of adult PWID who received at least one dose of oritavancin for a gram-positive infection between 1/1/17 and 6/30/19 at a large safety net hospital.ResultsTwenty three PWID received 24 courses of at least one dose of oritavancin for a gram-positive infection; 16 were experiencing homelessness at the time of diagnosis. Methicillin resistant Staphylococcus aureus (MRSA) was the most common infecting pathogen and bone or joint the most frequent infection site. Nineteen encounters resulted in clinical cure, including 5 whose conditions improved despite non-adherence to their prescribed regimen. Three patients experienced a non-favorable outcome. Two patients experienced mild adverse drug reactions that did not interfere with therapy; no patients died while on therapy.ConclusionOritavancin may be a clinically effective treatment option for the management of complicated gram-positive infections in PWID and patients experiencing homelessness. Further studies should be performed to validate these results.

Survival With Continuous Outpatient Intravenous Inotrope Therapy in the Modern Era.

To describe baseline characteristics and outcomes in the largest known registry of advanced heart failure (HF) patients receiving continuous outpatient intravenous inotrope therapy. Studies evaluating the use of outpatient inotropes for palliation or as a bridge to advanced therapies were performed before current guideline directed medical and device therapy (GDMDT). There are limited data on the modern experience using outpatient inotrope (OI) therapy. We aimed to study current use and outcomes of OI. Retrospective database analysis. From 2015 to 2017, 1540 advanced HF patients in a largess nationwide registry received OI with either milrinone or dobutamine. Baseline characteristics of 1149 patients data were retrospectively reviewed. Unadjusted Kaplan-Meier survival estimates censored at the time of transplant or mechanical circulatory support were reported. Of 1149 patients, more patients were treated with milrinone than dobutamine (64.6% vs. 35.4%). Regardless of the indication for OI, estimated 1 and 2-years survival was 61.8% and 41.6%, respectively. Milrinone use was associated with a greater 1-year survival than dobutamine (70.7% vs. 46.2%, P < 0.0001). The superiority of milrinone over dobutamine extended to all indications for OI, including bridge to transplant (85.9% vs. 71.3%, P < 0.0001), bridge to mechanical support (91.4% vs. 71%, P = 0.001), and palliation (73.6% vs. 63.3%, P < 0.001). After adjusting for indication, age, gender and weight, milrinone was associated with lower mortality than dobutamine (HR 0.50, 95% CI 0.39-0.64, P < 0.0001). In the largest dataset of HF patients receiving OI, survival on OI for palliation in the current era of GDMDT is significantly higher than previously reported. Compared with dobutamine, milrinone was associated with improved survival in all cohorts.

How do I develop a process to effectively treat parturients with iron deficiency anemia?

Anemia is common in pregnant women and is associated with increased morbidity for the mother and the fetus, including increased risk of allogeneic blood transfusion. Iron deficiency is the most common etiology for anemia during pregnancy. Oral iron therapy remains the standard treatment but is often poorly tolerated due to its gastrointestinal side effects. Intravenous iron has been shown to be a safe and effective way to treat iron deficiency anemia but may be challenging to do in the outpatient setting given the need for an indwelling venous catheter and a small risk of infusion reactions. To improve outcomes associated with anemia, we launched a program to refer and treat obstetric patients with iron deficiency anemia for outpatient intravenous iron therapy through our preoperative anemia clinic. Here, we describe the process and successes of our program, including the clinical outcomes (change in hemoglobin and transfusion rates) from the first 2 years of the program.

Baseline features of the VICTORIA (Vericiguat Global Study in Subjects with Heart Failure with Reduced Ejection Fraction) trial.

Describe the distinguishing features of heart failure (HF) patients with reduced ejection fraction (HFrEF) in the VICTORIA (Vericiguat Global Study in Patients with Heart Failure with Reduced Ejection Fraction) trial. Key background characteristics were evaluated in 5050 patients randomized in VICTORIA and categorized into three cohorts reflecting their index worsening HF event. Differences within the VICTORIA population were assessed and compared with PARADIGM-HF (Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) and COMMANDER HF (A Study to Assess the Effectiveness and Safety of Rivaroxaban in Reducing the Risk of Death, Myocardial Infarction, or Stroke in Participants with Heart Failure and Coronary Artery Disease Following an Episode of Decompensated Heart Failure). VICTORIA patients had increased risk of mortality and rehospitalization: New York Heart Association class (40% class III), atrial fibrillation (45%), diabetes (47%), hypertension (79%) and mean estimated glomerular filtration rate of 61.5 mL/min/1.73 m2 . Baseline standard of HF care was very good: 60% received triple therapy. Their N-terminal pro-B-type natriuretic peptide was 3377 pg/mL [interquartile range (IQR) 1992-6380]. Natriuretic peptides were 30% higher level in the 67% patients with HF hospitalization <3months, compared to those within 3-6months of HF hospitalization and those randomized after recent outpatient intravenous diuretic therapy. Overall the median MAGGIC (Meta-Analysis Global Group in Chronic Heart Failure) risk score in VICTORIA was 23 (IQR 18-27) as compared to the MAGGIC risk score in PARADIGM-HF of 20 (IQR 16-24). VICTORIA comprises a broadly generalizable high-risk population of three unique clinical strata of worsening chronic HFrEF despite very good HF therapy. VICTORIA will establish the role of vericiguat, a soluble guanylate cyclase stimulator, in HFrEF.

Continuous Outpatient Intravenous Inotrope Therapy: Milrinone is Associated with Improved Survival Compared to Dobutamine Irrespective of Indication

Introduction Continuous outpatient intravenous inotrope therapy (COIIT) is a treatment strategy used in stage D heart failure as a bridge to advanced therapies [bridge-to-decision (BTD); bridge-to-mechanical support (BTMS); bridge-to-transplant (BTT)] or as palliation (PAL). Long-term survival associated with COIIT in the modern era of guideline directed medical and device therapy (GDMDT) is poorly defined. Our objective is to describe the survival of patients undergoing COIIT with milrinone or dobutamine in the modern era. Hypothesis In patients undergoing COIIT for various indications, milrinone - which allows for more effective neurohormonal antagonism with beta blockade - has a more favorable survival profile than dobutamine. Methods We retrospectively analyzed data from a large US registry of patients receiving COIIT (milrinone or dobutamine) from 2015-17. Patients with incomplete data or Results Of 1,149 patients on COIIT (mean age 60 years, 29.9% female), 260 (22.6%) patients died during the study period. Mortality was higher in patients undergoing COIIT for palliation than for bridge therapy (1-year survival: 55.0% vs 65.6%, p Conclusions In the largest data set reported to date of patients receiving COITT in the current era of GDMDT, milrinone use was associated with improved survival compared to dobutamine. A randomized, controlled trial in this growing patient population is warranted.

Improved Survival on Palliative Home Inotropes in the Modern Era

Introduction Continuous outpatient intravenous inotrope therapy (COIIT) is a treatment strategy in stage D heart failure as bridge to advanced therapies or palliation. Studies conducted before the era of modern guideline directed medical and device therapy (GDMDT) have demonstrated poor outcomes for palliative COIIT, with survival rates as low as 25% at 1 year. Our objective is to describe the outcomes of patients receiving palliative COIIT in the current era of GDMDT. Hypothesis Overall survival on palliative COIIT has improved in the era of GDMDT. The choice of inotrope (milrinone or dobutamine) has an impact on survival. Methods We retrospectively analyzed data from a large US registry of patients receiving COIIT (milrinone or dobutamine) from 2015-17. Patients were included if the indication for COIIT was palliation and excluded if they had incomplete data or Results Of 1,149 registry patients receiving COIIT, the indication was palliation in 404 (35%). The mean age was 65 years, and 30% were women. During the study period, 124 (31%) patients died. Estimated survival at 1 and 2 years was 55% and 42% respectively (Figure Panel A). Milrinone was used in 235 (58%) patients and dobutamine in 169 (42%). Compared to patients treated with dobutamine, patients treated with milrinone had greater survival at 1 year (63% vs 43%, p=0.0003) and 2 years (47% vs 34%, p=0.0003). Median survival was estimated at 699 days for milrinone and 247 days for dobutamine (Figure Panel B). The use of high-dose milrinone (≥0.375 mcg/kg/min) was associated with greater survival than either low-dose milrinone or low- or high-dose dobutamine (Figure Panel C). Conclusion Survival on palliative COIIT appears to be higher than previously reported, and milrinone use was associated with better survival than dobutamine. Prospective studies of palliative COIIT are urgently needed.

Daily outpatient intravenous antibiotic therapy for the management of paediatric periorbital cellulitis, a retrospective case series.

To evaluate whether outpatient treatment of periorbital cellulitis with daily administration of intravenous antibiotics and physician evaluation is an effective and safe alternative to admission. A retrospective chart review study of paediatric patients treated on an outpatient basis for periorbital cellulitis at a tertiary children's hospital between 2013 and 2015 was performed. Children were assessed day by a paediatrician to monitor for resolution of symptoms or complications. The Montreal Children's hospital, a tertiary care centre. Children diagnosed with an uncomplicated periorbital cellulitis secondary to an acute sinusitis or upper respiratory tract infection. The number of days of intravenous antibiotics, complications or need for subsequent admission. Complications were defined as formation of an abscess or phlegmon confirmed on computerised tomography scan, worsening or recurrent persistent cellulitis, failure to improve on intravenous antibiotics, and intracranial complications. Sixty-six children with a diagnosis of uncomplicated periorbital cellulitis secondary to sinusitis who received intravenous antibiotics via medical day hospital and who fit the inclusion criteria were identified. The mean duration of intravenous antibiotic therapy was 4.1days. All children received ceftriaxone, with one patient also receiving cefuroxime. Two of 66 patients developed complications; one patient required admission for failure to improve/subperiosteal phlegmon and later underwent functional endoscopic sinus surgery, and one patient developed an eyelid abscess that did not require admission. No patients developed severe neurological or visual deficits. Outpatient intravenous therapy with daily reassessment by a physician may be a safe alternative to admission in select cases of periorbital cellulitis without systemic signs of illness.

Scheduled Outpatient Intravenous Infusion per Headache Protocol and Effect on Migraine-related Quality of Life in Patients with Chronic Daily Headaches

Chronic Daily Headache (CDH) and Medication overuse headaches (MOH) are important public health problems. CDH is defined as a headache occurring on 15 days or more per month over three month duration with a worldwide prevalence of 4%. MOH is a daily or near daily headache over 15 days a month that results from overuse of migraine abortive medications and is one of the most common chronic headache disorders (worldwide prevalence of 1-2%). A total of 56 patients were enrolled in the study. 51 patients completed a one month follow-up and 39 patients completed a two month follow-up. After informed consent, migraine specific quality of life questionnaire (MSQ 2.1) and patient rating of migraine specific measures were administered on the first day of treatment and at 5 and 10 weeks following completion of treatment. The protocol included IV DHE, IV magnesium, IV Decadron, IV Depacon based on standard factors identified by the headache specialist and as needed Toradol, Benadryl and anti-nausea medications headache frequency and severity was decreased. Migraine associated photophobia and phonophobia improved markedly (p<0.0001) and number of people needing abortive medication more than 10 days a month was reduced by 40%. The data provide evidence for the efficacy of scheduled outpatient intravenous therapy per the headache center protocol for CDH and suggests that patients experience diminished frequency and intensity of headaches with improved quality of life one month and two months post therapy. Outpatient settings and timings provided a more comfortable and time effective setting to patients and families with decrease visits to the emergency room with a will prove to be a more cost effective method of treatment.

Health-care associated pneumonia

Health-care associated pneumonia (HCAP) is defined as pneumonia that develops in patients with a history of recent hospitalization, hemodialysis as an outpatient, residence in a nursing home, outpatient intravenous therapy and home wound care. We retrospectively assessed patients who have been hospitalized in Department of Chest Diseases, Akdeniz University, Faculty of Medicine due to HCAP between 1 January 2009 and 1 June 2012. Of the total 195 pneumonia cases, 76 (38.9%) was HCAP and 119 (61.1%) was CAP. Among HCAP cases, 61 (80.3%) had recent hospitalisation in the last 90 days, 7 (9.2%) went under hemodialysis in the last 30 days, 3 (3.9%) had a history of decubitus management in house, 1 (1.3%) had a long term accomodation in social-care center and 1 (1.3%) had a history of infusion therapy at home. Comorbidity in HCAP group was higher than CAP group (94.6% vs resp. 73.1%; p< 0.001) and mean PSI scores were also higher in HCAP group (104.4 - 90.2; p< 0.05). A causative microorganism was detected in 18 HCAP (23.6%) and in 11 CAP (9.2%) cases. It was determined that appropriate treatment was started in 73.7% of HCAP cases and 98.3% of CAP cases according to national and international guidelines (p< 0.001). Both mean hospitalization duration (12.7 ± 1.1 vs 7.8 ± 0.5 days, resp; p< 0.05) and mortality rates (22.4% vs 4.2%; p< 0.001) were higher in HCAP group. Furthermore, mean cost of hospitalization was also greater for HCAP group than CAP group (4150.6 ± 892 TL vs 2078.7 ± 571 TL; respectively p< 0.05). In conclusion; patient characteristics, comorbidity status, causative organisms, duration and cost of hospitalization and prognosis of patients with HCAP was different from patients with CAP.

Prevalence and predictors of initial oral antibiotic treatment failure in adult emergency department patients with cellulitis: a pilot study

IntroductionAssessment of cellulitis severity in the emergency department (ED) setting is problematic. Given the lack of research performed to describe the epidemiology and management of cellulitis, it is unsurprising that...