In patients receiving outpatient parenteral antimicrobial therapy (OPAT), infectious disease follow-up within 2 weeks was associated with a lower risk for all-cause 30-day hospital readmission, according to study findings published in Clinical Infectious Diseases.
In this retrospective 1:1 pair-matched case-control study at a large academic medical center in Pennsylvania, researchers analyzed data of 1102 patients receiving OPAT. The case group comprised patients who were readmitted within 30 days of hospital discharge (n=201) and the control group was made up of patients who did not have a readmission (n=901).
Of the 201 patients readmitted within 30 days, 97 were readmitted for reasons categorized as OPAT-related; the most common was worsening or complication of infection. Acute kidney injury was the most common adverse drug reaction resulting in readmission. Of the readmitted patients, 133 (66%) were readmitted within 14 days of discharge; OPAT-related readmission accounted for 62 of these cases.
In the multivariable analysis, which included variables that were significant in bivariable analyses, patients who were seen for an infectious disease follow-up within 2 weeks had a significantly lower risk of having 30-day readmission (adjusted odds ratio [aOR] 0.33; 95% CI, 0.19-0.59; P =.001). Consistent with the bivariable analyses, ceftriaxone had a lower risk for readmission (aOR 0.49; 95% CI, 026-0.92; P =.03), whereas immunosuppression had a higher risk for readmission (aOR 2.79; 95% CI, 1.17-6.64; P =.02).
Results from a subgroup analysis of 73 cases and their matching controls, who were readmitted ≤7 days after discharge, supported the finding that early infectious disease follow-up was associated with a lower risk for readmission in this subgroup (aOR 0.091; 95% CI, 0-0.45; P =.004).
Varied follow-up times requested by physicians was a limitation of this study. In addition, patients with orthopedic infections were generally seen earlier, as infectious disease follow-up occurred simultaneously with the first orthopedic follow-up visit. Moreover, researchers were unable to analyze the microbiology of the infections.
“We would recommend focusing [on] early [infectious disease] outpatient follow-up for OPAT patients, especially those who are immunosuppressed,” concluded the investigators.
Saini E, Ali M, Du P, Crook T, Zurlo J. Early ID outpatient follow-up of OPAT patients reduces 30-day readmission [published online February 4, 2019]. Clin Infect Dis. doi:10.1093/cid/ciz073