External validity and clinical usefulness of a risk prediction model for 30 day unplanned hospitalization in patients receiving outpatient parenteral antimicrobial therapy.

OBJECTIVES: Outpatient parenteral antimicrobial therapy (OPAT) is increasingly used to treat a variety of infections. However, hospital readmissions remain relatively common. We examined the external validity and clinical usefulness of a previously derived risk prediction model for 30 day unplanned hospitalization in patients receiving OPAT. METHODS: A retrospective cohort study was conducted at two large teaching hospitals in the UK. The design comprised quasi-external temporal validation on patients from the same OPAT setting as the model development, and broader external validation on patients from a different setting. The model predictors were age, prior hospitalizations in the preceding 12 months, Charlson comorbidity score, concurrent IV antimicrobial therapy, type of infection and mode of OPAT treatment. Discriminative ability, calibration and clinical usefulness were assessed. RESULTS: Data from 2578 OPAT patients were analysed. The rates of 30 day unplanned hospitalization were 11.5% (123/1073), 12.9% (140/1087) and 25.4% (106/418) in the model derivation, temporal validation and broader external validation cohorts, respectively. The discriminative ability of the prediction model was adequate on temporal validation (c-statistic 0.75; 95% CI: 0.71-0.79) and acceptable on broader validation (c-statistic 0.67; 95% CI: 0.61-0.73). In both external cohorts, the model displayed excellent calibration between observed and predicted probabilities. Decision curve analysis showed increased net benefit across a range of meaningful risk thresholds. CONCLUSIONS: A simple risk prediction model for unplanned readmission in OPAT patients demonstrated reproducible predictive performance, broad clinical transportability and clinical usefulness. This model may help improve OPAT outcomes through better identification of high-risk patients and provision of tailored care.

Clinical and operational factors associated with treatment duration for cellulitis in outpatient parenteral antimicrobial therapy (OPAT).

This study aims to identify factors associated with duration of intravenous (IV) and follow-on oral antibiotic therapy for cellulitis in patients treated through outpatient parenteral antimicrobial therapy (OPAT). A retrospective review of episodes of cellulitis treated over a year (January 2018-January 2019) at a large teaching hospital in Sheffield, UK. Overall, 292 OPAT episodes of cellulitis were reviewed. The mean durations of IV therapy and follow-on oral antibiotics were 5.3 days (range 1-32 days) and 6.1 days (range 2-17 days), respectively. Age, peak C-reactive protein and frequency of medical assessments during OPAT were independently associated with longer duration of IV therapy. Senior clinicians were likely to prescribe shorter courses of follow-on oral antibiotics. IV to oral conversion was more likely to occur on the first day of the work week. Our findings suggest that clinical and OPAT-related factors can influence early conversion to oral antibiotic therapy.