Parenteral Antibiotic Therapy Research Articles

A case-control study of the clinical and economic impact of infections caused by Carbapenemase-producing Enterobacterales (CPE).

The aim was to analyse the clinical and economic impact of carbapenemase-producing Enterobacterales (CPE) infections. Case-control study. Adult patients with CPE infections were considered cases, while those with non-CPE infections were controls. Matching criteria were age (± 5years), sex, source of infection and microorganism (ratio 1:2). Primary outcome was 30-day mortality. Secondary outcomes were 90-day mortality, clinical failure, hospitalisation costs and resource consumption. 246 patients (82 cases and 164 controls) were included. Klebsiella pneumoniae OXA-48 was the most common microorganism causing CPE infections. CPE cases had more prior comorbidities (p = 0.007), septic shock (p = 0.003), and were more likely to receive inappropriate empirical and definitive antibiotic treatment (both p < 0.001). Multivariate analysis identified septic shock and inappropriate empirical treatment as independent predictors for 7-day and end-of-treatment clinical failure, whereas Charlson Index and septic shock were associated with 30- and 90-day mortality. CPE infection was independently associated with early clinical failure (OR 2.18, 95% CI, 1.03-4.59), but not with end-of-treatment clinical failure or 30- or 90-day mortality. In terms of resource consumption, hospitalisation costs for CPE were double those of the non-CPE group. CPE cases had longer hospital stay (p < 0.001), required more long-term care facilities (p < 0.001) and outpatient parenteral antibiotic therapy (p = 0.007). The CPE group was associated with worse clinical outcomes, but this was mainly due to a higher comorbidity burden, more severe illness, and more frequent inappropriate antibiotic treatment rather than resistance patterns as such. However, the CPE group consumed more healthcare resources and incurred higher costs.

Outpatient parenteral antibiotic treatment for infective endocarditis: A retrospective observational evaluation

BackgroundInfective endocarditis (IE) requires long courses of intravenous (IV) antibiotics. Outpatient parenteral antibiotic therapy (OPAT) saves resources, improves the patient experience and allows care in their preferred place; however, questions remain about safety when treating IE patients. This study evaluates OPAT management of IE patients in our region between 2006 and 2019. MethodsThis is a retrospective observational evaluation and description of outcomes and adherence to suitability criteria, according to British Society for Antimicrobial Chemotherapy (BSAC) guidelines. ResultsWe identified five models of OPAT delivery. The number of patients treated expanded significantly over time. Of 101 patients, six (6%) suffered poor outcomes, but each patient had contributing factors outside of the primary infection. Median OPAT duration was 12 days and 1,489 hospital bed days were saved. ConclusionsIn a setting where there was good adherence to BSAC criteria, treating IE patients using OPAT services was safe. Complications observed were likely independent of treatment location. Significant bed days were saved.

Lemierre&amp;apos;s Syndrome and Nasopharyngitis in Children: DIAGNOSIS and Treatment

Introduction: Lemierre’s syndrome (LS) is a rare but serious infectious emergency. It can be life threatening. It is a sepsis difficult to recognize and most often due to Fusobacterium necrophorum. The purpose of this case report was to discuss the diagnosis and treatment of Lemierre syndrome in children. Observation: A three-year-old child consulted for rhinopharyngitis complicated by an abscessed cervical adenophlegmon. The symptomatology had been evolving for 7 days with a notion of self-medication. The blood cell count showed hyperleukocytosis at 14.06.10&amp;lt;sup&amp;gt;3&amp;lt;/sup&amp;gt; elements/mm&amp;lt;sup&amp;gt;3&amp;lt;/sup&amp;gt;, anemia at 8.2.10&amp;lt;sup&amp;gt;6&amp;lt;/sup&amp;gt; elements/mm&amp;lt;sup&amp;gt;3&amp;lt;/sup&amp;gt;, and platelets at 102.10&amp;lt;sup&amp;gt;3&amp;lt;/sup&amp;gt; elements/mm&amp;lt;sup&amp;gt;3&amp;lt;/sup&amp;gt;. CRP was 258.5 mg/dL. HIV serology was negative. Bacteriological culture of the biological fluids collected (abscess pus, blood and joint fluid) was sterile. The CT scan revealed a collection of abscesses in the right sub-angulo-mandibular region. It was associated with thrombophlebitis of the internal jugular vein, as well as pulmonary and joint infections. The diagnosis of Lemierre syndrome was done. Cervicotomy allowed drainage of the abscess. A triple parenteral antibiotic therapy (Ceftriaxone, Metronidazole, Gentamycin) with per-os relay by Amoxicillin + Clavulanic Acid allowed to obtain the cure in one month of treatement without complications. Conclusion: LS is difficult to diagnose due to its non-specific clinical presentation and low incidence. Early clinical and imaging diagnosis guarantees a good outcome by allowing adequate treatment.

Preliminary Experience With Commercially Available Trabecular Metal Tibial Cones Combined With a Retrograde Locked Intramedullary Nail for Bony Defects in Tibiotalocalcaneal Arthrodesis.

Critical sized bone defects in the ankle are becoming increasingly more common in patients undergoing limb reconstruction with tibiotalocalcaneal arthrodesis. Bulk allografts have not fared well over time. There have been scattered preliminary reports using custom spinal cages or 3D-printed Titanium Implants to address the critical bony defect; however, the cost of these devices is prohibitive in many clinical practice settings. The purpose of this investigation is to report the preliminary experience using a commercially available Trabecular Metal (Zimmer-Biomet) tibial metaphyseal cone combined with a retrograde locked intramedullary nail to address this challenging problem. Eight consecutive patients underwent tibiotalocalcaneal arthrodesis using a commercially available Trabecular Metal tibial metaphyseal cone combined with a retrograde locked intramedullary nail. Five developed bone loss secondary to neuropathic (Charcot) bony resorption and 3 underwent surgery for failed total ankle arthroplasty. All 8 patients eventually achieved clinical and radiographic healing and were able to ambulate with standard footwear. One patient developed a postoperative wound infection at the site of calcaneal locking screws, which resolved with debridement and parenteral antibiotic therapy. Critical bone defects about the ankle have successfully addressed with custom 3D titanium implants. This small series suggests that similar clinical outcomes can be achieved with the use of a commercially available porous tantalum metaphyseal spacer borrowed from our arthroplasty colleagues, combined with the use of a retrograde locked intramedullary nail.Levels of Evidence: Level 4: Retrospective case series.

Anaerobic Antibiotic Coverage in Aspiration Pneumonia and the Associated Benefits and Harms: A Retrospective Cohort Study

BackgroundAntibiotics with extended anaerobic coverage are commonly used to treat aspiration pneumonia, which is not recommended by current guidelines. Research questionIn patients admitted to hospital for community-acquired aspiration pneumonia, is there a difference between antibiotic therapy with limited anaerobic coverage (LAC) versus antibiotic therapy with extended anaerobic coverage (EAC) in terms of in-hospital mortality and risk of Clostridioides difficile colitis? MethodsWe conducted a multicenter retrospective cohort study across 18 hospitals in Ontario, Canada from January 1, 2015 to January 1, 2022. Patients were included if the physician diagnosed the patient with aspiration pneumonia and prescribed guideline-concordant first-line community-acquired pneumonia parenteral antibiotic therapy within 48 hours of admission. Patients were then categorized into LAC group if they received ceftriaxone, cefotaxime or levofloxacin. Patients were in the EAC group if they received amoxicillin-clavulanate, moxifloxacin, or any of ceftriaxone, cefotaxime, or levofloxacin in combination with clindamycin or metronidazole. The primary outcome was all-cause mortality in hospital. Secondary outcomes included incident C. difficile colitis occurring after admission. Overlap weighting of propensity scores was used to balance baseline prognostic factors. ResultsThere were 2,683 and 1,316 patients in the LAC and EAC group respectively. In hospital, 814 (30.3%) and 422 (32.1%) patients in the LAC and EAC group died respectively. C. difficile colitis occurred in 5 or less (≤0.2%) and 11 to 15 (0.8% to 1.1%) patients in the LAC and EAC group respectively. After overlap weighting of propensity scores, the adjusted risk difference of EAC minus LAC was 1.6% (95% CI -1.7% to 4.9%) for in-hospital mortality and 1.0% (95% CI 0.3% to 1.7%) for C. difficile colitis. InterpretationExtended anaerobic coverage is likely unnecessary in aspiration pneumonia because it is associated with no additional mortality benefit, only an increased risk of C. difficile colitis.

Urinary tract infection in pediatric patients – Recent updates

In children, urinary tract infection (UTI) is a common condition. Prompt identification and treatment are critical for reducing morbidity associated with this illness. Throughout infancy, the symptoms and indications remain nonspecific. During the first 2 years of life, the most prevalent sign of UTI is unexplained fever. Symptoms and indicators of pyelonephritis after the 2nd year of life include fever, chills, rigor, flank discomfort, and costovertebral angle tenderness. Suprapubic pain, dysuria, urinary frequency, urgency, murky urine, malodourous urine, and suprapubic tenderness are examples of the lower tract symptoms and indicators. When UTI is suspected, a urinalysis and urine culture should be conducted. In the treatment of acute uncomplicated UTI, second or third-generation cephalosporin and amoxicillin-clavulanate are currently the medications of choice. Parenteral antibiotic therapy is advised for infants under 2 months of age and any child who seems toxic is hemodynamically unstable, is immunocompromised, is unable to tolerate, or is not responding to oral medication. This study focuses on the most recent updates about UTIs in children and provides a comprehensive overview of the subject.

Stability of meropenem in portable elastomeric infusion devices: which protocol should be implemented in clinical practice?

Meropenem has an excellent activity against gram-positive and gram-negative bacteria, including multi-resistant microorganisms. Even though meropenem is a great candidate for outpatient parenteral antimicrobial therapy (OPAT), its physicochemical stability is a major challenge. This work aimed to demonstrate the suitability of including meropenem in OPAT by elucidating its physicochemical stability in a range of commonly prescribed concentrations within portable elastomeric infusion devices. Physical and chemical stability were evaluated at two concentrations commonly used in clinical practice (2 and 25 mg/mL), and three temperatures (2°C-8°C, 25°C, and 32°C) using Accufuser portable elastomeric infusion devices. Drug adsorption onto portable elastomeric infusion devices was also determined at the end of the experiment. Meropenem stability significantly decreased at higher temperatures and when higher drug solution concentrations were used. Meropenem solutions at 2 mg/mL kept the drug content above 95% over 24 h at 2°C-8°C but just for 8 h at 25°C. Nevertheless, solutions containing 25 mg/mL of meropenem showed a dramatic decrease in chemical stability after 8 h 2°C-8°C and just after 4 h at 25°C or 32°C. However, physical stability was kept favorable during this period. The drug adsorption on the material of the elastomeric infusion device was below 1%, indicating the suitability of the chosen device. We propose several administration protocols for meropenem in portable elastomeric infusion devices in clinical practice, according to the results obtained in our study. The results obtained in this study open up the possibility of administering meropenem in an OPAT setting despite its short stability.IMPORTANCEAlthough outpatient parenteral antibiotic therapy can be a good approach to treating infections, a lack of data regarding antibiotic stability in portable elastomeric infusion devices restricts its safe and effective use. Actually, meropenem is used for prolonged periods above 24 h, and it is not physicochemically stable, which can compromise efficacy and toxicity. This work is of high importance to show the clinicians the real shelf life of meropenem when administered in portable elastomeric infusion devices. We propose several administration protocols for meropenem in portable elastomeric infusion devices in clinical practice, according to the stability drug results obtained in our study.

The success rate and complications of midline catheters in pediatric outpatient parenteral antibiotic therapy (OPAT)

The use of outpatient parenteral antimicrobial therapy (OPAT) for children has several advantages, including reduced length of hospital stay and costs. A reliable vascular access is key to delivering safe and effective pediatric OPAT. In recent years, midline catheters (MC) have been increasingly used for short-term intravenous antibiotic therapy in children. However, there are no studies investigating the use of MCs in the OPAT setting. The main aim of this paper was to evaluate the success and complications of using MCs for pediatric OPAT. This was a retrospective cohort study from a tertiary academic pediatric hospital. All MCs inserted at the hospital and used for OPAT were eligible for study inclusion. The primary objective was to describe the percentage of patients able to complete OPAT without the need for additional venous access. Forty-one MCs were included in the study. Patient mean (SD) age was 5.9 (4.9) years. In 31 cases (76%, 95% CI 62–86%), the iv therapy could be successfully completed using only the MC. Imbalances between the groups suggested unfavorable outcome for saphenous vein catheters as well as for shorter and smaller-sized catheters. Fourteen patients (34%) were subjected to a MC-related complication. Pain on injection in the MC was the most frequent complication (n = 10, 24%). Conclusion: Midline catheters could be an alternative to central venous access for pediatric OPAT. Avoiding saphenous vein insertion and using longer and larger-sized catheters could increase MC success rate. No severe MC-related complication was found. Further randomized studies comparing different catheter types are needed.What is Known:• For selected patients, pediatric outpatient parenteral antimicrobial therapy (OPAT) is safe and provides health-economic, psychosocial, and medical advantages compared to in-hospital care.• A reliable venous access is one of the key factors to the success of OPAT, but this can be a challenge in children.What is New:• Using midline catheters, 76% of patients could complete their intended iv therapy without the need for additional venous access. Avoiding saphenous vein insertion and using longer and larger-sized catheters could increase the success rate.• Thirty-four percent of catheters were subject to some kind of complication, the most common being pain on injection in the catheter.

Making the EHR Work for You-Modifications of an Electronic Health Record System to Improve Tracking and Management of Patients Receiving Outpatient Parenteral Antibiotic Therapy.

Managing the complex needs of outpatient parenteral antibiotic therapy (OPAT) patients is challenging and time-consuming. We describe development of multimodal interventions to facilitate patient management within an Epic® (Epic Systems Corporation)-based electronic health record (EHR) platform. During 2016-2018, a multidisciplinary team created several modifications in our local EHR to improve gaps in OPAT care, including shared note templates, shared patient lists, automatically triggered notifications, and comprehensive order sets. A SmartForm was created, allowing collection of discrete, self-contained extractable data about each OPAT episode. We reviewed OPAT episodes from January 2019 through December 2022. The multimodal EHR interventions culminated in the creation of a patient report, the "OPAT Monitoring View" collating OPAT-relevant data from multiple sections of the chart onto 1 screen display. This view is accessible both within the patient chart and from multiple list-based, in-basket, and snapshot-anchored preview functions in the EHR. Implementation of the EHR bundle facilitated management of 3402 OPAT episodes from 2019 to 2022 (850 episodes/year), about 50% higher than anticipated based on 540 OPAT courses in 2016. The OPAT EHR bundle allowed efficient (<3 hours) multidisciplinary rounds for management of 130-145 patients each week, streamlining of care transitions, and increasing staff satisfaction. Bundled multimodal modifications to the local EHR increased patient care efficiency and staff satisfaction and facilitated data collection to support a large OPAT program. These modifications apply commonly available EHR functionalities to OPAT care and could be adapted to other settings with different EHR platforms.

Creation and Validation of an Automated Registry for Outpatient Parenteral Antibiotics.

Existing outpatient parenteral antibiotic therapy (OPAT) registries are resource intensive, and OPAT programs struggle to produce objective data to show the value of their work. We describe the building and validation of an automated OPAT registry within our electronic medical record and provide objective data on the value of the program. Variables and outcomes include age, sex, race, ethnicity, primary insurance payor, antibiotic names, infection syndromes treated, discharge disposition, 30-day all-cause readmission and death rates, complications, and an estimate of the hospital days saved. Records for 146 OPAT episodes were reviewed manually to validate the registry. Data were displayed in a dashboard within the electronic medical record. Over the 4-year time frame, our registry collected 3956 unique patients who completed 4710 episodes (approximately 1200 episodes per year). A total of 400 complications during OPAT were identified. All variables had an accuracy of >90% on validation. The OPAT program resulted in a reduction in hospital length of stay by 88 820 days, or roughly 22 000 days per year. We intend our registry to serve as a blueprint for similar OPAT programs with limited administrative resources. Wider application of our system would allow for easier aggregation and comparisons of OPAT practice and address the lack interinstitutional standardization of OPAT data and outcomes.

Experience with dalbavancin use in various gram-positive infections within Aberdeen Royal Infirmary OPAT service

PurposeDalbavancin, approved in 2014 for Gram-positive acute bacterial skin and skin structure infections (ABSSSI), has pharmacokinetics enabling treatment with one or two doses. Dalbavancin might be useful in outpatient parenteral antibiotic therapy (OPAT) of deep-seated infections, otherwise requiring inpatient admission. We documented our experience with pragmatic dalbavancin use to assess its effectiveness for varied indications, on- and off-label, as primary or sequential consolidation therapy.MethodsPatients prescribed dalbavancin between 1 December 2021 and 1 October 2022 were screened for demographics of age, sex, Charlson comorbidity index (CCI), allergies, pathogens, doses of dalbavancin, other antibiotics administered and surgery. Where available, infection markers were recorded. The primary outcome was a cure at the end of treatment. Secondary outcomes included any adverse events and for those with treatment failures, response to salvage antibiotics.ResultsSixty-seven per cent of patients were cured. Cure rates by indication were 93% for ABSSSI, 100% for bacteraemia, 90% for acute osteomyelitis, 0% for chronic osteomyelitis, 75% for native joint septic arthritis and 33% for prosthetic joint infection. Most bone and joint infections that were not cured did not have source control, and the goal of treatment was suppressive. Successful suppression rates were greater at 48% for chronic osteomyelitis and 66% for prosthetic joint infections. Adverse events occurred in 14 of 102 patients.ConclusionThis report adds to clinical experience with dalbavancin for off-label indications whilst further validating its role in ABSSSI. Dalbavancin as primary therapy in deep-seated infections merits investigation in formal clinical trials.

Acute mastoiditis in cochlear implanted children: A single-centre experience

BackgroundAcute mastoiditis (AM) is the most common complication of acute otitis media and primarily affects children under the age of two; current data on its prevalence in paediatric patients with cochlear implant (CI) are still scant. Proper management of AM in CI children is crucial in order to avoid the implications (financial and emotional) of an explant.Aim of this paper is to describe the cases of AM occurred among young patients with CI in follow up at our department, also in order to evaluate its prevalence, potential predisposing factors, clinical course and therapeutic strategies. Patients and methodsRetrospective study. Medical records of all paediatric patients with CI, who had at least one year of follow-up, were searched aiming to identify those who developed AM, from January 1st 2002 to January 31st 2022. The following data were collected and analysed: demographic features, implant type and side, interval between CI surgery and AM, treatment, laboratory tests, clinical course, vaccination history, associated diseases. ResultsAM was developed by six (1.3%) of the 439 children with CI (541 implanted ears). In total, 9 episodes (2.05 %) were recorded, as three patients reported two consecutive infections. Average time interval between CI surgery, to the first or only AM diagnosis, was 13.8 months (range 3–30 months). Furthermore, 3/6 of patients had a history of recurrent acute otitis media; 2/6 an autism spectrum disorder, associated to a combined immune deficiency in one case. All patients were hospitalized and promptly treated by intravenous antibiotic therapy; 4/6 also underwent a mastoidectomy. CI was not explanted in any cases of this series. ConclusionsOver a 20-year period, AM rate in CI children was 1.3%, which is consistent with the current literature rates of 1–4.7%. All cases were successfully treated, preserving the integrity of the device. In our experience, the early parenteral antibiotic therapy and, when necessary, surgical treatment were adequate to eradicate the infection.

Successful outpatient parenteral antibiotic therapy with cefiderocol for osteomyelitis caused by multi-drug resistant Gram-negative bacteria: a case report.

Post-traumatic osteomyelitis attributed to metallo-β-lactamase (MBL)-producing Gram-negative bacteria presents a challenging clinical scenario. Cefiderocol emerges as a viable treatment option within the limited therapeutic options available. In this brief report, we present a case of a Ukrainian patient with osteomyelitis caused by multi-drug resistant Pseudomonas aeruginosa, which was successfully treated with cefiderocol, facilitated in part by outpatient parenteral antibiotic therapy (OPAT). Administration of Cefiderocol via OPAT can present a safe and effective option for treatment of post-traumatic osteomyelitis with multi-drug resistant Pseudomonas aeruginosa. A possible effect on iron homeostasis of extended treatment duration with cefiderocol may be taken into consideration.

Unilateral Parotid Gland Enlargement in Newborn: Is it Suppurative Parotitis?

Acute neonatal suppurative parotitis (ANSP) is a rare disease and a novel illness affecting newborns and premature neonates are more likely to contract it. A unilateral parotid swelling and pus discharge from the Stensen’s duct is pathognomonic and sonography is the first line tool to supplement the diagnosis of parotitis. An appropriate parenteral antibiotic therapy and adequate hydration are the mainstays of treatment. Herein, we report a case of ANSP in a 12-day-old baby girl with a 48-hour history of left pre-auricular swelling where a complete resolution of disease was achieved post-treatment.

Development of quality indicators for antimicrobial stewardship in Belgian hospitals: a RAND – modified Delphi procedure

ABSTRACT Introduction Inappropriate antibiotic use is a major cause of antibiotic resistance. Therefore, optimizing antibiotic usage is essential. In Belgium, optimization of antimicrobials for the fight against multidrug resistant organisms (MDROs) is followed up by national surveillance by public health authorities. To improve appropriate antimicrobial use in hospitals, an effective national Antimicrobial Stewardship (AMS) program should include indicators for measuring both the quantity and quality of antibiotic use. Objectives The aim of this study was to develop a set of process quality indicators (QIs) to evaluate and improve AMS in hospitals. Methods A RAND-modified Delphi procedure was used. The procedure consisted of a structured narrative literature review to select the QIs, followed by two online questionnaires and an intermediate multidisciplinary panel discussion with experts in infectious diseases from general and teaching hospitals in Belgium. Results A total of 38 QIs were selected after the RAND-modified Delphi procedure, from which 11 QIs were selected unanimously. These QIs address compliancy of antibiotic therapy and prophylaxis with local guidelines, documentation of the rationale for antibiotic treatment in the medical record, the availability of AMS Programs and Outpatient Parenteral Antibiotic Therapy, resistance patterns and antimicrobial prescribing during focused ward rounds. Conclusion Our study selected 38 relevant process QIs, from which 11 were unanimously selected. The QIs can contribute to the improvement of quality of antibiotic use by stimulating hospitals to present better outcomes and by providing a focus on how to intervene and to improve prescribing of antimicrobials.

Stability of meropenem in portable elastomeric infusion devices: which protocol should be implemented in clinical practice?

Although outpatient parenteral antibiotic therapy can be a good approach to treating infections, a lack of data regarding antibiotic stability in portable elastomeric infusion devices restricts its safe and effective use. Actually, meropenem is used for prolonged periods above 24 h, and it is not physicochemically stable, which can compromise efficacy and toxicity. This work is of high importance to show the clinicians the real shelf life of meropenem when administered in portable elastomeric infusion devices. We propose several administration protocols for meropenem in portable elastomeric infusion devices in clinical practice, according to the stability drug results obtained in our study.

A Comprehensive Review of Pyogenic Spondylitis Management for Neurosurgeons.

Older populations have been increasing recently, resulting in an increase in cases of pyogenic spondylitis. Neurosurgeons who frequently treat the elderly are at a higher risk of encountering this condition. Therefore, this article provides a summary of the literature and our experience to help neurosurgeons effectively manage pyogenic osteomyelitis. It is important not to rule out pyogenic spondylosis when examining a patient with back pain, even in the absence of a fever. This is because the chronic type is common, easily overlooked, and early diagnosis and treatment are crucial. Empirical antibiotics should be avoided in cases where blood culture and biopsy are negative, to prevent microbial resistance and an increase in difficult-to-treat cases. Biopsies, such as computed tomography-guided percutaneous biopsy and full endoscopic debridement and drainage, should be attempted. Currently, 6 weeks of parenteral antibiotic therapy is the main treatment for pyogenic spondylitis. Surgical treatment is recommended if this method is ineffective. However, in the early stages, full endoscopic debridement and drainage and percutaneous pedicle screw fixation are optional.

319. Infectious disease healthcare utilization and outcomes of patients discharged to skilled nursing facilities on parenteral antibiotic therapy

Abstract Background Hospitalized patients are frequently discharged to a skilled nursing facility (SNF) for parenteral antibiotic therapy (PAT). While there are studies describing the healthcare utilization and outcomes of individuals receiving post-hospital PAT in non-institutional settings, characterization of the PAT experience among SNF patients remains limited. To address this gap in knowledge, we conducted a retrospective cohort study of hospitalized patients discharged to a SNF on antimicrobial therapy. Methods Health records of patients (age ≥18 years) hospitalized in a single hospital who were discharged on systemic antibiotics to a SNF from 1/1/2016 - 12/31/2018 were reviewed. Subjects who received an inpatient ID consultation and were discharged on PAT were included. Information captured included patient demographics, diagnoses, discharge antibiotic regimen and timing, post-discharge encounters, 90-day hospital readmissions, and losses to follow-up. This study was approved by the Institutional Review Board with a waiver for informed consent. Results 155 patients meeting the inclusion criteria were identified. Post-discharge follow-up with the ID Service was not recommended for 19 patients (12.3%). Patients who followed-up post-discharge had a total of 264 sub-specialty provider (mean: 2.8/patient; range: 0-13) and 170 ID provider (mean: 1.7/patient; range: 0-5) face-to-face encounters within 90 days of discharge. Average time to ID clinic follow-up was 3.2 weeks (range: 1-6 weeks). ID clinic nursing staff conducted 1373 telephone encounters (mean: 13.9/patient; range, 3-40) with SNF nursing staff within 90 days of discharge. The 90-day hospital readmission rate was 37% (36/101 patients) and 47% of readmissions were ID-related. The 90-day mortality rate was 9%; 2 patients died before and 7 after outpatient follow-up was established. Conclusion ID clinic follow-up of patients discharged to a SNF on PAT was infrequent, but their care entailed a higher volume of telephone care coordination, and they experienced higher readmission rates relative to patients receiving PAT in ambulatory settings. Further studies to better understand if these findings are driven by patient factors or issues related to SNF care practices are needed. Disclosures All Authors: No reported disclosures

346. Evaluation of the Safety Profile of Cefazolin Monotherapy in Outpatient Parenteral Antibiotic Antimicrobial Therapy at a Large Academic Medical Center

Abstract Background The Infectious Diseases Society of America recommends serial safety lab monitoring during outpatient parenteral antimicrobial therapy (OPAT) to assess treatment response and prevent adverse events. However, these recommendations do not address the safety profile of specific antimicrobial agents or the ideal frequency of monitoring. Previous studies, using cohorts of fewer than 300 patients, report adverse event rates of less than 5% with outpatient cefazolin. It is possible that serial lab monitoring for patients on cefazolin monotherapy may represent unnecessary work and increase costs with minimal patient benefit. Methods A retrospective chart review was performed on patients treated with cefazolin monotherapy in the OPAT program of Brigham and Women’s Hospital (Boston, MA, USA) from February 2018 to February 2023. Data from weekly safety labs were examined during OPAT for the following abnormalities: change in creatinine (absolute increase of 0.5 mg/dL or relative increase ≥50%), ALT &amp;gt; 100 units/L, neutropenia (absolute neutrophil count &amp;lt; 1000 cells/mm3), eosinophilia ( &amp;gt;500 cells/mm3), and thrombocytopenia (&amp;lt; 100K/uL or relative decrease ≥50%). Other treatment complications adjudicated from chart review included antibiotic treatment changes, readmission, or mortality during OPAT. Results Among the 420 patients receiving cefazolin in OPAT, the median age was 62 (IQR: 49-71) years; 168 patients (40%) were women, and 62 (15%) were referred from oncology or transplant services. Twenty-four (6%) patients had at least one lab abnormality. Of these, 13 (3%) required a treatment change or had readmission or death. Eight (2%) cases were related to a lab abnormality, while five were due to other factors either unrelated to antibiotic therapy or apparent on clinical examination (e.g., rash). Conclusion In an OPAT program at a large academic medical center, weekly lab monitoring altered clinical decision-making for 2% of patients on cefazolin monotherapy. It may be reasonable to reduce the frequency of or eliminate routine lab monitoring for these patients to reduce the cost of healthcare services. Future studies are indicated to evaluate the clinical impact of less frequent lab monitoring for OPAT patients on cefazolin monotherapy. Disclosures David W. Kubiak, PharmD, BCPS, BCIDP, FIDSA, Astellas Pharma, Inc.: Advisor/Consultant|AVIR Pharma Inc: Advisor/Consultant|Cidara Therapeutics: Advisor/Consultant|Shionogi Inc: Grant/Research Support

342. Evaluation of Patient Satisfaction with Outpatient Parenteral Antibiotic Therapy (OPAT) at a University Medical Center

Abstract Background With the expansion of OPAT care over recent years, new devices such as elastomeric balls have been added to the available drug delivery options, which also include syringe, electronic pumps and gravity bags. The primary objective of this study was to evaluate the experience of patients (and their caregivers) on OPAT, ease of use with various delivery methods, and barriers to outpatient care. Methods The survey included questions on IV antibiotic received, delivery method, who administered the medicines, effect on daily activities, ease of access to staff, and thoughts on various aspects of the process and experience. Questions were multiple choice, based on Likert scale, or open-ended. Patients were recruited in person during infectious diseases (ID) clinic visits, or by phone, just before or around the time OPAT ended. Results We had 51 responses from 130 patients from 10/1/22 thru 3/31/23. Median age group was 55-64 years, 45% were women, for 78% it was first OPAT episode, and 23% received &amp;gt; one IV drug. Syringe push was used for 37%, elastomeric ball for 38%, gravity bag for 18% and electronic pump for 7% of agents. Most (76%) received help in administering treatment by friend or family (spouse=75%). 44% of infusions were once/day and 27% were 3 or more times/day. Home nursing services were received by 94% (5 different agencies) and &amp;gt; 6 different infusion pharmacies supplied the medicines. Medicine was always delivered on time for 38 of 45 respondents. All patients found IV push and elastomeric ball easy to use; 25% disagreed with this about gravity bag or electronic pump. Overall satisfaction was 94% with OPAT course and 94% felt instructions on how to administer medicines at home were clear and easy. Financial hardships were noted by 9 of 48 respondents (12 responded “neutral”) and 77% had to curtail some or most of their daily activities while on OPAT. Conclusion Overall, patients’ responses were positive of our OPAT program. However, the large portion of patients needing to curtail their usual activities highlights the need for more study on how regimen details such as delivery device and infusion frequency impact patient and caregiver experience. Financial hardships may be underestimated as final bills may not yet have been received by patients. Disclosures All Authors: No reported disclosures