Factors associated with successful completion of outpatient parenteral antibiotic therapy in an area with a high prevalence of multidrug-resistant bacteria : 30-day hospital admission and mortality rates
Garbelini Salles, Thais Cristina (Hospital Santa Helena, Santo André, São Paulo, Brazil)
Cerrato, Santiago Grau (Universitat Autònoma de Barcelona. Departament de Farmacologia, de Terapèutica i de Toxicologia)
Santana, Tatiana Fiscina (UnitedHealth Group, São Paulo, São Paulo, Brazil)
Medeiros, Eduardo Alexandrino (Division of Infectious Diseases, Department of Internal Medicine, Paulista School of Medicine, Federal University of São Paulo, Brazil)

Data:	2020
Resum:	To identify factors associated with hospital admission and mortality within the first 30 days after enrolment in an outpatient parenteral antimicrobial therapy (OPAT) program, also analysing adequacy of the treatment regimen and clinical outcomes. This was a retrospective cohort study conducted between October 2016 and June 2017 in the state of São Paulo, Brazil. Variables related to hospital admission and mortality were subjected to bivariate analysis, and those with a P <0. 05 were subjected to multivariate analysis as risk factors. We evaluated 276 patients, of whom 80. 5% were ≥60 years of age and 69. 9% had more than one comorbidity. Of the patients evaluated, 41. 3% had pneumonia and 35. 1% had a urinary tract infection. The most common etiological agent, isolated in 18 (31. 6%) cases, was Klebsiella pneumoniae, and 13 (72,2%) strains were carbapenem resistant. The OPAT was in accordance with the culture results in 76. 6% of the cases and with the institutional protocols in 76. 4%. The majority (64. 5%) of the patients were not admitted, and a cure or clinical improvement was achieved in 78. 6%. Multivariate analysis showed that, within the first 30 days after enrolment, the absence of a physician office visit was a predictor of hospital admission (P <0. 001) and mortality (P = 0. 006). This study demonstrated the viability of OPAT in elderly patients with pulmonary or urinary tract infections in an area with a high prevalence of multidrug-resistant bacteria and that a post-discharge physician office visit is protective against hospital admission and mortality.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	PloS one, Vol. 15 (november 2020) , ISSN 1932-6203

DOI: 10.1371/journal.pone.0241595
PMID: 33206669

11 p, 580.8 KB

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