Antimicrobial stewardship in the outpatient parenteral antimicrobial therapy (OPAT) setting: the impact of prescription assessment by an infectious diseases specialist

ABSTRACT Objective: In recent years, the use of outpatient parenteral antimicrobial therapy (OPAT) has increased, resulting in the need to ensure its rational and adequate utilization. This article describes the implementation of an antimicrobial stewardship program in the OPAT setting by a Health Maintenance Organization (HMO) and its results. Method: An infectious disease (ID) physician made routine assessments of all home care parenteral antimicrobial requests from February to December 2019. Information on diagnosis, renal function, weight, previous antimicrobials, and microbiology were gathered during remote evaluations. Prescription changes recommended by the ID specialist were not mandatory, but implemented by the primary provider as accepted. Antibiotic consumption data was analyzed from January 2018 to December 2019. An active screening was conducted for treatment failures: two or more treatment course requirements, or death within 15 days of the evaluation were reexamined. Results: A total of 506 antimicrobial requests were assessed. The most frequent diagnoses were urinary tract infection, pneumonia, and orthopedic surgical site infection. Six percent of evaluations were not completed due to insufficient information and 12% were requests by the primary physician for initial antimicrobial guidance. Of the 416 completed prescriptions evaluations, 58% had suggested changes, including different antimicrobials (40%), treatment duration (25%), and route of administration (23%). There was an increase in use of teicoplanin and meropenem, and a decrease in ceftriaxone, ertapenem, cefepime, amikacin and daptomycin use. The HMO's overall parenteral antimicrobial outpatient consumption, which had shown an upward trend over the previous year, decreased after program initiation. No major adverse results were detected in patients' clinical outcomes; two treatment failures were detected and promptly corrected; no deaths attributed to antibiotic changes were detected. Conclusion: Outpatient antimicrobial stewardship, through remote assessment by an ID specialist, was effective and safe in the OPAT setting.

The Characteristics of Patients Referred to an Infectious Diseases Physician in a Community-Based Hospital in Korea / 감염과화학요법

BACKGROUND: The infectious diseases physicians will increasingly make their way into the community. But there is few data about the role of the infectious diseases physicians in the community in Korea. MATERIALS AND METHODS: Patients admitting to a division of infectious diseases in a community-based tertiary hospital were analyzed retrospectively during 24 months from 2004. The analysis included patients characteristics, the pattern of referral, causative diseases, the type of infectious diseases, causative organisms, diagnostic methods, and the feature of fever of unknown origin (FUO). RESULTS: 362 patients were included. 64.1% admitted via emergency room with significantly higher severity. 51.1% of patients had referral impression of FUO. The average duration of admission was 10.7 days with median 5 days. The patients had infectious diseases in 81.8%, non-infectious diseases in 5.2%, and unknown causes in 13.0%. The causative infectious diseases included scrub typhus (25.3%), skin and soft tissue infections (16.6%), lower respiratory infections (13.9%) and urinary tract infections (10.8%). The diagnostic tools for the causative organisms included culture (34.8%), serology (28.7%), staining (5.6%) and the clinical decision (30.3%). The causes of FUO were infectious diseases in 71.9 %, non-infectious diseases in 6.0% and unknown in 22.1%. The overall mortality rate was 6.9%. CONCLUSION: Most of the diseases referred to an infectious diseases physician in the community were community-acquired febrile infectious diseases with high severity, which needed conventional diagnostic principles in infectious diseases and an initial intensive therapeutic approach. The relative high incidence of skin and soft tissue infections were notable. Self-transfer by patients to several well- known hospitals was noted if there was no definite diagnosis in about a week after admission. This indicated a limitation of sophisticated FUO work-up in a community-based hospital without high name value.

The Characteristics of Patients Referred to an Infectious Diseases Physician in a Community-Based Hospital in Korea / 감염과화학요법

BACKGROUND: The infectious diseases physicians will increasingly make their way into the community. But there is few data about the role of the infectious diseases physicians in the community in Korea. MATERIALS AND METHODS: Patients admitting to a division of infectious diseases in a community-based tertiary hospital were analyzed retrospectively during 24 months from 2004. The analysis included patients characteristics, the pattern of referral, causative diseases, the type of infectious diseases, causative organisms, diagnostic methods, and the feature of fever of unknown origin (FUO). RESULTS: 362 patients were included. 64.1% admitted via emergency room with significantly higher severity. 51.1% of patients had referral impression of FUO. The average duration of admission was 10.7 days with median 5 days. The patients had infectious diseases in 81.8%, non-infectious diseases in 5.2%, and unknown causes in 13.0%. The causative infectious diseases included scrub typhus (25.3%), skin and soft tissue infections (16.6%), lower respiratory infections (13.9%) and urinary tract infections (10.8%). The diagnostic tools for the causative organisms included culture (34.8%), serology (28.7%), staining (5.6%) and the clinical decision (30.3%). The causes of FUO were infectious diseases in 71.9 %, non-infectious diseases in 6.0% and unknown in 22.1%. The overall mortality rate was 6.9%. CONCLUSION: Most of the diseases referred to an infectious diseases physician in the community were community-acquired febrile infectious diseases with high severity, which needed conventional diagnostic principles in infectious diseases and an initial intensive therapeutic approach. The relative high incidence of skin and soft tissue infections were notable. Self-transfer by patients to several well- known hospitals was noted if there was no definite diagnosis in about a week after admission. This indicated a limitation of sophisticated FUO work-up in a community-based hospital without high name value.