Keller, Sara C.

Abstract Objective: Outpatient parenteral antimicrobial therapy (OPAT) programs continue to evolve with increases in multidisciplinary teams, complex oral antibiotics, long-acting injectable antimicrobials, patients with substance use disorder (SUD) and telehealth. We sought to examine how OPAT programs are currently structured and identify barriers to safe care. Design: Cross-sectional survey. Participants: Physician, pharmacist, and advanced practice providers (APP) Emerging Infections Network (EIN) members. Methods: A survey was conducted between February and March 2025 to assess OPAT structure, expansion to complex outpatient antimicrobial therapy (COpAT), and barriers to safe OPAT care. Results: Of 1639 EIN members, 622 (38%) responded; 75% reported an active role in OPAT. Oversight of patients on COpAT was reported by 59%, and mandatory ID consultation for OPAT by 59%. Eighty-one percent reported >75% of OPAT patients were followed by ID. Most patients received OPAT at home (78%) followed by post-acute care facilities. Outpatient and inpatient ID physicians were responsible for laboratory test monitoring (75% and 30% respectively), while 37% reported a multidisciplinary OPAT team and 32% reported non-specialists. Respondents cited inadequate support in data analysis, administration, information technology and financial support for clinical staff. Common challenges were lack of leadership awareness (51%), difficulty managing patients with SUD (50%) and timely access to laboratory test results (48%). Conclusions: ID physicians were commonly involved in OPAT care, with many programs expanding to COpAT. Several barriers to the safe delivery of OPAT remain, including lack of institutional support, reimbursement and poor communication between stakeholders.

Abstract Objective: Outpatient parenteral antimicrobial therapy (OPAT) is a mainstay of clinical infectious diseases practice, and OPAT-related publications continue to be prominent in journals. The objective of this article is to summarize ten clinically important OPAT-related publications from 2024. Design: Narrative review. Methods: Eighty-one articles were found in a literature search, and 56 met inclusion criteria. A survey containing 25 articles was sent to an email listserv of clinicians with OPAT experience. Results: This article summarizes the top 10 OPAT articles published in 2024, based on those survey results. Conclusions: Common themes from the top 10 OPAT articles published in 2024 included OPAT clinician workload, patient perspectives of OPAT, tools for OPAT work, and dalbavancin use.

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) practice has continued to increase. We sought to understand current OPAT practices in a survey of U. S. clinicians.Figure 1Respondents rated their agreement with the following statement: “The OPAT program at my hospital receives adequate support in the following areas”Figure 2Factors present in providing safe OPAT services on a scale where 1 is “extremely challenging” and 5 is “not challenging at all” Methods A survey instrument was developed by ID physicians, pharmacists and Infectious Diseases Society of America (IDSA) Emerging Infections Network (EIN) staff, utilizing prior EIN OPAT surveys. The survey focused on respondents’ role, responsibilities, time devoted to OPAT, structure of OPAT provision, location where OPAT is received, institutional support and oversight, role of complex outpatient antimicrobial therapy (COpAT) including oral antimicrobials and long-acting injectable agents, and barriers to safe OPAT care. The confidential survey was distributed to adult EIN members from Feb to March 2025. Results Overall, 622 (38%) EIN members responded to the survey, of whom 469 with a role in managing OPAT patients were eligible to complete the survey. OPAT teams varied across programs with nearly all involving ID physicians (98%), majority involving ID/OPAT pharmacists (61%), nurses (60%), and nearly half involving administrative staff (48%) and advanced practice providers (APPs, 47%). ID consultation for OPAT enrollment was required in 60% of programs. Many programs (59%) report including COpAT. Response to outpatient lab results was largely managed by ID physicians (75%); however, multidisciplinary OPAT teams (37%), pharmacists (33%), and inpatient ID physicians (30%) were also frequently involved. Lab values were most often available via fax/email (43%) or electronic health record (EHR, 41%). Nearly 25% of programs “often/always” required proactive outreach to obtain safety labs. Overall, many programs lacked data analysis, administrative, information technology, and financial support (Figure 1). Challenges faced by OPAT programs included lack of leadership awareness of the value of OPAT (51%), difficulty managing patients with substance use disorder (50%), access to timely lab values (48%), personnel to retrieve missing lab values (46%), and struggles with the EHR (43%) (Figure 2). Conclusion Compared to EIN OPAT surveys in 2013 and 2019, programs have grown in size and composition, and expanded to COpAT. Similar problems persist regarding perceived lack of support. Disclosures Monica V. Mahoney, PharmD, BCPS, BCIDP, FCCP, FIDSA, FIDP, FMSHP, gsk: Advisor/Consultant|seqirus: Advisor/Consultant Philip M. Polgreen, MD, Eli Lily: Advisor/Consultant|Pfizer: Grant/Research Support Sara C. Keller, MD, MPH, MSPH, CorMedix: Grant/Research Support

Abstract Outpatient parenteral antimicrobial therapy (OPAT) has become more common in infectious diseases practice settings. Similarly, OPAT-related publications have also increased. The objective of this article was to summarize clinically important OPAT-related publications from 2023. Eighty-one articles were found on initial search, with 52 meeting inclusion criteria. A survey containing the 19 articles that had at least 1 citation was sent to an email listserv of multidisciplinary clinicians with OPAT experience. This article summarizes the “top 10” 2023 OPAT articles from the survey results.

Abstract Outpatient parenteral antimicrobial therapy (OPAT) has become more common in clinical settings. Correspondingly, OPAT-related publications have also increased; the objective of this article was to summarize clinically meaningful OPAT-related publications in 2022. Seventy-five articles were initially identified, with 54 being scored. The top 20 OPAT articles published in 2022 were reviewed by a group of multidisciplinary OPAT clinicians. This article provides a summary of the “top 10” OPAT publications of 2022.

Abstract As outpatient parenteral antimicrobial therapy (OPAT) becomes more common, it may be difficult to stay current with recent related publications. A group of multidisciplinary OPAT clinicians reviewed and ranked all OPAT publications published in 2021. This article provides a high-level summary of the OPAT manuscripts that were voted the “top 10” publications of 2021.

Abstract Respiratory tract infections (RTIs) drive many outpatient encounters and, despite being predominantly viral, are associated with high rates of antibiotic prescriptions. With rising antibacterial resistance, optimization of prescribing of antibiotics in outpatients with RTIs is a critical need. Fortunately, this challenge arises at a time of increasing availability of novel RTI diagnostics to help discern which patients have bacterial infections warranting treatment. Effective implementation of antibiotic stewardship is needed, but optimal approaches for ambulatory settings are unknown. Future research needs are reviewed in this summary of a research summit convened by the Infectious Diseases Society of America in the fall of 2019.