Factors associated with all-cause 60-day readmission in patients with end-stage renal disease on hemodialysis discharged on outpatient parenteral antimicrobial therapy
Recommended Citation
Ismail G, Mulugeta S, Gendjar S, Daifi C, Kenney R, and MacDonald NC. Factors associated with all-cause 60-day readmission in patients with end-stage renal disease on hemodialysis discharged on outpatient parenteral antimicrobial therapy. Am J Health Syst Pharm 2025.
Document Type
Article
Publication Date
7-21-2025
Publication Title
American journal of health-system pharmacy
Abstract
PURPOSE: Outpatient parenteral antimicrobial therapy (OPAT) is standard of care in patients who require intravenous antibiotics after hospitalization. There is a lack of data on OPAT in patients with end-stage renal disease on hemodialysis. This study characterized hemodialysis patients discharged on OPAT and identified factors associated with all-cause 60-day hospital readmission.
METHODS: This institutional review board-approved retrospective cohort study included hemodialysis patients 18 years of age or older who were discharged from January 2020 to August 2022 with at least 1 week of OPAT. Enrolled patients were divided into 2 groups depending on their 60-day readmission status (ie, readmitted and nonreadmitted) and compared to identify risk factors associated with readmission. Treatment success, adverse event (ADE) rates, and transition-of-care process measures were also assessed.
RESULTS: A total of 162 patients were included in the study, with 81 patients in each group. The most common indication for OPAT was bloodstream infection (n = 83, 51%). The median time to first readmission was 24 days (interquartile range, 11-45 days). After adjusting for confounders, nonreadmitted patients were more likely to have a pharmacist infection treatment plan note before discharge (adjusted odds ratio [aOR], 0.195; 95% confidence interval [CI], 0.039-0.977) and to have attended infectious disease (ID) follow-up appointments (aOR, 0.337; 95% CI, 0.161-0.705). Female sex was associated with increased risk of all-cause 60-day readmission (aOR, 3.352; 95% CI, 1.738-6.467; P < 0.001). The rate of changes in OPAT after discharge, the number of reported ADEs, and the number of emergency department visits were all significantly higher in the readmitted group.
CONCLUSION: This study suggests that pharmacist-led education, attending follow-up ID appointments, and male sex are associated with reduced risk of all-cause 60-day readmission in hemodialysis patients.
Medical Subject Headings
hemodialysis; infectious diseases; outpatient parenteral antimicrobial therapy; pharmacy; readmission; transitions of care
PubMed ID
40689653
ePublication
ePub ahead of print
