OPAT Therapy During COVID-19: Care and Management Strategies

The following article is a part of conference coverage from the American Academy of PAs 2021 Conference (AAPA 2021), held virtually from May 23 to May 26, 2021. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading PAs. Check back for more from AAPA 2021.

 

Use of outpatient parenteral antibiotic therapy (OPAT) during the COVID-19 pandemic resulted in shortened lengths of hospital stay, potentially reduced costs and risk for nosocomial infections, and convenient care for patients receiving antibiotic therapy.

An overview of practices by the OPAT team at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, which included 2 infectious disease attending physicians, a clinical pharmacist, and a physician assistant, was presented by Katharine Breaux, PA-C, and colleagues in a poster session at the American Academy of PAs 2021 Conference (AAPA 2021).

To ensure continued and appropriate follow-up of patients on OPAT, the team used live video or telephone visits enhanced by the inclusion of digital photographs. Weekly OPAT Team Huddles were added to the process to review safety concerns, patient issues, tracked issues, and potential planned discharges that would include OPAT therapy. Patients eligible for OPAT were evaluated before discharge for safety and feasibility.

Antibiograms were used to guide antibiotic selection. Both culture and sensitivity data were used to determine antibiotic susceptibility or resistance for specific pathogens, using in-house data from the VA Medical Center with organism susceptibility classified as ≥90%, 80% to 89%, and <79%.

A review of cases supported with OPAT demonstrated that gram-positive (nonurine) isolates were the most commonly identified organisms. Diagnoses included hardware infections, osteomyelitis, and diabetic foot wounds. Drug toxicities and line malfunctions were also noted in the review.

Complications of OPAT therapy included asymptomatic creatinine kinase elevations in a patient with methicillin-resistant Staphylococcus aureus (MRSA), cefazolin-induced dyshidrotic eczema, and progressive dry gangrene in a patient with diabetes and osteomyelitis and a dislodged line.

“Successful OPAT must be well-coordinated with attention to detail by multiple stakeholders,” including a clinical pharmacist, PA, the patient and their caregivers, infusion companies, and home health providers, the researchers noted.

A PA is “well-positioned to be the clinician that provides coordination of care, is able to make clinical decisions, particularly in complex patients with multiple comorbidities, and communicate with all stakeholders,” the presenters concluded.

Visit Clinical Advisor’s meetings section for complete coverage of AAPA 2021.

Reference

Breaux K, Khan P, Robins A, Hu X. Outpatient parenteral antibiotic therapy (OPAT) during the COVID-19 pandemic: A dedicated team effort to ensure appropriate follow-up. Presented at: American Academy of PAs 2021 Conference; May 23-26, 2021. Poster 235.

This article originally appeared on Clinical Advisor