OPAT for Complicated Staph Infections

Among patients discharged with OPAT for complicated staph infections, 1/3 had an adverse event and nearly 2/3 were re-admitted within 90 days. Patients discharged to a skilled nursing facility (SNF) were lost to follow up at higher rates than those discharged with home care services (HCS) and had higher incidence of line complications. What surprised me was that the ID clinic only received labs from 44% of patients at SNF and 53% at HCS. But at the end of the day, both discharge locations had similar rates of “favorable outcomes”, 61% vs 70%. The SNF vs home care comparison maybe confounded because older and sicker patients are more likely to be sent to SNF/SAR

We often discharge patients on long courses of parenteral antibiotics for Staphyloccus auerus infections and we must recognize they are likely to face significant adverse events and complications. It is unclear if this is due to the severity of the underlying infection, and more importantly, could it have been prevented with closer inpatient monitoring. This study should give you pause when sending patients to SAR/SNF on long term IV antibiotics.

Open Forum Infectious Diseases, Volume 5, Issue 11, 1 November 2018, ofy274