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. 2022 Oct;65(10):946-952.
doi: 10.1111/myc.13513. Epub 2022 Aug 16.

Antifungal use via outpatient parenteral antimicrobial therapy

Su M Chew  1 , Christopher H Heath  1   2   3   4 , Cecilia Petursson  2 , Peter A Boan  1   2   3 , James Owen Robinson  1   2   3   5 , Claire M Italiano  2 , John R Dyer  1 , Laurens Manning  1   6 , Paul R Ingram  1   2   3   4
Affiliations

Antifungal use via outpatient parenteral antimicrobial therapy

Su M Chew et al. Mycoses. 2022 Oct.

Abstract

Background: Antifungal administration via outpatient parenteral antimicrobial therapy (OPAT) is infrequent. As patients with invasive fungal infections (IFIs) receiving OPAT are at high risk of readmissions, careful, risk-based patient selection and monitoring is important.

Objectives: To describe our experience managing IFIs via OPAT, including assessment of risk factors associated with unplanned readmissions.

Patients and methods: A retrospective cohort study of outpatients from two tertiary hospitals in Western Australia managed with parenteral antifungals for the treatment of IFIs from 2012 to 2020. Outcomes assessed were unplanned OPAT-related readmissions; adverse events and achievement of treatment aim at the completion of OPAT.

Results: Forty-six patients were included, encompassing 696 OPAT days. Twenty-three (50%) patients received intravenous (IV) liposomal amphotericin B (L-AmB), 23 (50%) received IV echinocandins and one (2%) patient received IV fluconazole. One patient received both IV L-AmB and an echinocandin. Unplanned OPAT-related readmissions occurred in 13 (28%) patients and any adverse event occurred in 19 (41%), most commonly nephrotoxicity amongst patients receiving L-AmB. On univariate analysis, unplanned OPAT-related readmissions were more common in Mucorales infection, L-AmB doses of ≥5 mg/kg and otorhinolaryngologic (ENT) infections. At the completion of OPAT, attainment of treatment aims occurred in 28 (61%) patients.

Conclusions: Patients receiving parenteral antifungals via OPAT experience high rates of unplanned readmissions and adverse events. Risk factor identification may facilitate optimal patient selection and establishment of treatment aims.

Keywords: anti-infective agents; invasive fungal infections; outpatients.

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References

REFERENCES

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