Discharge Delays and Costs Associated with Outpatient Parenteral Antimicrobial Therapy for Multi-drug-resistant Organisms: Opportunities for Improvement

Document Type

Conference Proceeding

Publication Date

1-11-2026

Publication Title

Open Forum Infect Dis

Keywords

avibactam plus ceftazidime, carbapenem, cefiderocol, ceftolozane plus tazobactam, eravacycline, meropenem plus vaborbactam, tigecycline, abdominal infection, adult, antimicrobial therapy, cohort analysis, conference abstract, drug administration, drug cost, drug therapy, female, hospitalization, human, intravenous drug administration, length of stay, major clinical study, male, medicaid, medicare, multidrug resistance, oral drug administration, outpatient, patient referral, retrospective study

Abstract

Background: The coordination of outpatient parenteral antimicrobial therapy (OPAT) transitions of care is challenging in patients with multi-drug-resistant organisms (MDRO) due to complexity of care. The study purpose was to describe barriers and medication costs associated with OPAT utilizing novel therapies for MDRO. Abbreviations: OPAT, outpatient parenteral antimicrobial therapy Hosmer-Lemeshow Goodness of Fit testing: Chi-square, 0.030, P=0.985 Methods: IRB approved, retrospective cohort of hospitalized adults infected with MDRO that were medically stable for discharge (MSDC) with an intended OPAT for cefiderocol, ceftazidime/avibactam, ceftolozane/tazobactam, eravacycline, meropenem/ vaborbactam, or tigecycline from 01/01/2017-03/31/2025. Cohorts included patients who received an intended OPAT regimen or a modified OPAT regimen, defined as transition to alternative intravenous (IV)/oral therapy, in-hospital completion of IV therapy, or in-hospital death. Secondary outcomes included post-MSDC medication costs, excess hospitalization, and opportunities for oral-switch therapy. Results: 120 patients were included. 29% had a modified OPAT regimen; 46% completed therapy inpatient and 23% were transitioned to oral therapy. Of the total population, the majority were men (58%) and had Medicare (53%). Intra-abdominal infections were common (38%), and most organisms were carbapenem-resistant (89%). β-lactams were the most intended OPAT regimen (67%). Patients with a modified OPAT regimen had significantly higher medication costs ($4828 [$1209-$18066] vs $1975 [$494-$4872], P< 0.001), more frequently experienced discharge delays ≥ 1 day (89% vs 66%, P=0.011) and prolonged length of stay (LOS) (20 [14-46] vs 13 [7-27], P=0.023), and more commonly required a change in discharge referral disposition (40% vs 16%, P=0.006) when compared to those who received an intended OPAT regimen. An oral-switch therapy opportunity was identified in 40% of patients. After adjusting for Medicaid, referral disposition changes and β-lactam therapy were associated with an increased odds of receiving a modified OPAT regimen (Table 1). Conclusion: Modified OPAT regimens were common and associated with increased costs, prolonged LOS, and discharge delays in patients with MRDO infections. Findings support use of oral-switch therapy and improved care coordination.

Volume

13

First Page

S670

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