(WHS-P1.03) DOES OPAT IMPROVE LONG TERM OUTCOMES FOLLOWING HOSPITILIZATION FOR FOOT INFECTIONS ?
Friday, May 17, 2024
10:30 AM – 11:30 AM East Coast USA Time
Background Diabetic foot ulcers are a common complication of diabetes that is associated with both high morbidity and mortality. It is estimated that the United States alone spends up to $13 billion USD each year on DFUs, with individual costs rising to $15,000 per year. Much of this expenditure has been attributed to lengthy hospital stays and inpatient care, with the need prolonged antibiotic therapy. Outpatient antibiotic therapy (OPAT) is a service that provides intravenous antimicrobial medication in the outpatient setting and has been shown to reduce hospital stay and overall medical costs. This study aims to determine the benefit of OPAT therapy in a cohort with soft tissue and bone foot infections. Methods Retrospective cohort study of consecutive patients hospitalized for foot infection. We collected demographic data, co-morbidities and one-year outcomes including healing, surgical interventions, number of surgeries, length of stay, re-infection, and re-hospitalization. Patients were grouped by discharge with OPAT program or standard of care. All patients were followed for a minimum of one year. Statistics were performed using Stata Be7. Continuous variables were reported as mean ± standard deviation and categorical variables were reported as their n. Odds ratios were written as O.R, followed by their associated confidence interval [CI]. Significance was determined as p≤0.05. Results A total of 382 patients with hospitalized lower extremity infections were analyzed in this cohort. There were 202 subjects with osteomyelitis and 180 subjects with soft tissue infections. OPAT was used in 99 patients . The primary outcomes examined in this study included reinfection, amputation, mortality, rehospitalization of the same foot, and length of stay. The overall events included 168 reinfections, 206 amputations, 9 deaths, 165 rehospitalizations for the target limb. OPAT was significantly associated with reinfection OR = 2.2 [CI: 1.3 – 3.5] and rehospitalization of the same foot O.R = 2.4 [CI: 1.5-3.9] . A sub analysis was further conducted for only the patients with diabetes (n = 294). An association was seen between OPAT and reinfection O.R = 2.1 [CI:1.3-3.6] and rehospitalization for the target limb O.R = 2.4 [CI: 1.4- 4.0] as well. Sub analysis was also performed for patients with osteomyelitis (n=202). OPAT was protective of index amputation O.R = 0.3 [CI: 0.1-0.6] and associated with rehospitalization of index limb O.R = 2.1 [CI: 1.1- 3.7]. Conclusion OPAT is associated with reinfection and rehospitalization of the target limb in this cohort. These findings were strongly related to patients with diabetes while no significant findings were observed in patients without diabetes.