To identify risk factors for failure of OPAT （outpatient parenteral antimicrobial therapy） among veterans with SAB （Staphylococcus aureus bacteremia）, a retrospective review was conducted of all patients receiving...To identify risk factors for failure of OPAT （outpatient parenteral antimicrobial therapy） among veterans with SAB （Staphylococcus aureus bacteremia）, a retrospective review was conducted of all patients receiving OPAT for SAB between 01/2011-09/2013 at a large, tertiary-care VA （Veterans＇ Affairs） medical center. Treatment failure was defined as incomplete therapy, therapy extension, infection relapse, or hospital admission or surgical intervention within 60 days of therapy completion. Of 118 SAB patients treated with OPAT, 101 met inclusion criteria. Treatment failure occurred in 36 （35.6%） patients. In multivariate analysis, heart failure （OR 3.67; CI 1.13-12.0）, previous OPAT （OR 14.1; CI 2.02-97.8）, immunosuppression （OR 10.5; CI 1.74-63.3）, and treatment with daptomycin （OR 9.56; CI 1.89-48.4） were independently associated with failure. A trend toward lower failure rates was seen in the community living center, a VA long-term care facility possessing its own infectious diseases consultation service. In veterans with SAB, specific health factors were associated with higher rates of OPAT failure. Given the morbidity and cost of SAB treatment failures, similar analyses may benefit other large OPAT programs to optimize the selection of patients and settings in which successful treatment will most likely occur.展开更多
文摘To identify risk factors for failure of OPAT （outpatient parenteral antimicrobial therapy） among veterans with SAB （Staphylococcus aureus bacteremia）, a retrospective review was conducted of all patients receiving OPAT for SAB between 01/2011-09/2013 at a large, tertiary-care VA （Veterans＇ Affairs） medical center. Treatment failure was defined as incomplete therapy, therapy extension, infection relapse, or hospital admission or surgical intervention within 60 days of therapy completion. Of 118 SAB patients treated with OPAT, 101 met inclusion criteria. Treatment failure occurred in 36 （35.6%） patients. In multivariate analysis, heart failure （OR 3.67; CI 1.13-12.0）, previous OPAT （OR 14.1; CI 2.02-97.8）, immunosuppression （OR 10.5; CI 1.74-63.3）, and treatment with daptomycin （OR 9.56; CI 1.89-48.4） were independently associated with failure. A trend toward lower failure rates was seen in the community living center, a VA long-term care facility possessing its own infectious diseases consultation service. In veterans with SAB, specific health factors were associated with higher rates of OPAT failure. Given the morbidity and cost of SAB treatment failures, similar analyses may benefit other large OPAT programs to optimize the selection of patients and settings in which successful treatment will most likely occur.
