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Antifungal use via outpatient parenteral antimicrobial therapy
Su M Chew1, Christopher H Heath1,2,3,4, Cecilia Petursson2
1Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia.
Background:
Antifungal administration via outpatient parenteral antimicrobial therapy (OPAT) is infrequent. As patients with invasive fungal infections (IFIs) receiving OPAT are at high risk of readmissions, careful, risk-based patient selection and monitoring is important.
Objectives:
To describe our experience managing IFIs via OPAT, including assessment of risk factors associated with unplanned readmissions.
Patients And Methods:
A retrospective cohort study of outpatients from two tertiary hospitals in Western Australia managed with parenteral antifungals for the treatment of IFIs from 2012 to 2020. Outcomes assessed were unplanned OPAT-related readmissions; adverse events and achievement of treatment aim at the completion of OPAT.
Results:
Forty-six patients were included, encompassing 696 OPAT days. Twenty-three (50%) patients received intravenous (IV) liposomal amphotericin B (L-AmB), 23 (50%) received IV echinocandins and one (2%) patient received IV fluconazole. One patient received both IV L-AmB and an echinocandin. Unplanned OPAT-related readmissions occurred in 13 (28%) patients and any adverse event occurred in 19 (41%), most commonly nephrotoxicity amongst patients receiving L-AmB. On univariate analysis, unplanned OPAT-related readmissions were more common in Mucorales infection, L-AmB doses of ≥5 mg/kg and otorhinolaryngologic (ENT) infections. At the completion of OPAT, attainment of treatment aims occurred in 28 (61%) patients.
Conclusions:
Patients receiving parenteral antifungals via OPAT experience high rates of unplanned readmissions and adverse events. Risk factor identification may facilitate optimal patient selection and establishment of treatment aims.
Insights
Outpatient parenteral antimicrobial therapy (OPAT) for invasive fungal infections (IFIs) is linked to high readmission and adverse event rates. Identifying risk factors is key for better patient selection and treatment success in antifungal OPAT.
Area of Science:
- Infectious Diseases
- Antimicrobial Therapy
- Clinical Outcomes
Background:
- Outpatient parenteral antimicrobial therapy (OPAT) for invasive fungal infections (IFIs) is uncommon.
- Patients with IFIs on OPAT face significant risks of hospital readmission.
- Careful patient selection and monitoring are crucial for managing IFIs in the OPAT setting.
Purpose of the Study:
- To evaluate the management of IFIs using OPAT.
- To identify risk factors associated with unplanned readmissions in patients receiving antifungal OPAT.
- To assess adverse events and treatment success rates.
Main Methods:
- Retrospective cohort study of 46 patients treated with parenteral antifungals for IFIs between 2012 and 2020.
- Data collected on unplanned OPAT-related readmissions, adverse events, and treatment aim achievement.
- Analysis of risk factors including antifungal agent, dosage, and infection site.
Main Results:
- 28% of patients experienced unplanned OPAT-related readmissions.
- 41% of patients had adverse events, with nephrotoxicity being common with liposomal amphotericin B (L-AmB).
- Higher readmission rates were linked to Mucorales infection, L-AmB doses ≥5 mg/kg, and otorhinolaryngologic infections.
Conclusions:
- Parenteral antifungal therapy via OPAT is associated with high rates of unplanned readmissions and adverse events.
- Identifying specific risk factors can improve patient selection for antifungal OPAT.
- Establishing clear treatment aims is important for successful outcomes in antifungal OPAT.
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