Long-Term Outpatient Parenteral Antimicrobial Therapy Deemed Safe



BOSTON – Serious infections requiring long-term treatment can be managed safely and effectively with outpatient parenteral antimicrobial therapy administered by infusion centers, a study has shown.

In an observational review of data from multiple infectious disease physician office infusion centers (POICs) over a 6-month period, the recurrence and readmission rates for patients treated for bacteremia, endocarditis, and osteomyelitis were low and more favorable than previously observed in similar studies, Dr. Michael P. Dailey reported at the annual meeting of the Infectious Diseases Society of America.

Of 203 patients (mean age 59 years) treated for bacteremia (54), infective endocarditis (26), and osteomyelitis (123) from Jan. 1, 2010, to June 30, 2010, 188 (93%) met the study criteria for clinical success, defined as cured or improved, while 13 (6%) and 19 (9%), respectively, experienced a recurrence within 6 months or required readmission during therapy, said Dr. Dailey of an infectious disease specialist in Roswell, Ga.

By infection type, 50 (93%) of the bacteremia patients, 23 (88%) of the endocarditis patients, and 115 (93%) of the osteomyelitis patients achieved clinical success, while the respective recurrence rates were 7 (13%), 0, and 6 (5%) and the respective readmission rates were 5 (9%), 3 (12%), and 19 (9%), he said, noting that "there were no statistical differences between diagnoses for readmissions or recurrences."

Of the full study population, 64 patients (32%) received all of their antimicrobial therapy in the POIC without hospitalization, and the mean duration in the POIC was 31 days, Dr. Dailey stated. The mean therapy durations by infection type were 20, 31, and 37 days for bacteremia, endocarditis, and osteomyelitis patients, respectively, he said.

Analysis of the safety outcomes showed that 53 patients (26%) had a total of 74 adverse events related to intravenous antibiotic treatment, including five serious adverse events that required either hospitalization or additional intervention, according to Dr. Dailey. Four patients had catheter-related infections, and three had catheter device failures that required removal or replacement, he said. Of the 19 readmissions, 4 each were due to adverse drug reactions and device failure, 3 were related to disease exacerbation, and 8 were for other medical complications, he said.

"Our results are more favorable than some of the other studies that have been reported over the past few years," Dr. Dailey stated, referring specifically to a collection of studies in which the treatment of patients with Staphylococcus aureus bacteremia with or without infective endocarditis was reported to be 86% compared with the 88% and 93% observed, respectively, in the endocarditis and bacteremic patients in the current investigation (J. Antimicrob. Chemother. 2009;63:1034-42).

The results suggest that the treatment of bacteremia, infective endocarditis, and osteomyelitis is safe and effective in the POIC setting, according to Dr. Dailey. "The recurrence and remission rates appear to be low in the outpatient setting as well," he said, acknowledging, however, that the study is limited by its size and its retrospective design. "Further investigation is warranted," he noted.

Dr. Dailey disclosed a financial relationship with Healix Infusion Therapy.

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