Ryan, Keenan

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.

Outpatient parenteral antimicrobial therapy (OPAT) has been widely used in clinical practice for many decades because of its associated cost savings, reductions in inpatient hospital days, and decreases in hospital-associated infections. Despite this long history, evolving practice patterns and new drug delivery devices continue to present challenges as well as opportunities for clinicians when designing appropriate outpatient antimicrobial regimens. One such change is the increasing use of extended and continuous infusion (CI) of antimicrobials to optimize the achievement of pharmacokinetic and pharmacodynamic targets. Elastomeric devices are also becoming increasingly popular in OPAT, including for the delivery of CI. In this article, we review the clinical evidence for CI in OPAT, as well as practical considerations of patient preferences, cost, and antimicrobial stability.

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 Background Outpatient parenteral antimicrobial therapy (OPAT) is an emerging area for pharmacist involvement. However, many residency training programs do not offer OPAT rotation opportunities for their residents. Objective To provide a blueprint for residency programs hoping to offer OPAT rotations for postgraduate year 1 (PGY1) or postgraduate year 2 (PGY2) pharmacy residents. Results As a rotation area with copious patient interaction, there are many unique accreditation objectives that can be taught and evaluated in an OPAT rotation. The OPAT rotation format may be longitudinal or block. Activities the resident can complete include predischarge evaluation, patient counseling, medication selection, physical examinations, laboratory monitoring, patient presentations, documentation, projects, and educational presentations. Conclusion OPAT rotations provide many opportunities for residents to satisfy the objectives required in residency training.

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) is the process of administering intravenous (IV) antimicrobials outside the acute inpatient setting. Oral antimicrobials for complex infections are referred to as complex outpatient antimicrobial therapy (COpAT). OPAT/COpAT programs are expanding, as are the opportunities for clinical Infectious Diseases (ID) pharmacists (RPHs) involvement. The current state of clinical (non-dispensing) role and the functions being performed by RPHs in OPAT/COpAT is unknown. Methods To define the current state of OPAT/COpAT pharmacy practice across the United States (US), specifically the clinical functions performed by RPHs, design of RPH involved OPAT/COpAT clinics, and compare training of RPHs who practice in OPAT/COpAT to ID RPHs who do not, a survey of a possible 31 questions was emailed to the American College of Clinical Pharmacists (ACCP) Infectious Diseases Practice and Research Network (PRN) email list. Results were focused on US-based respondents. Results Eighty-seven RPHs responded with 27 practicing in OPAT/COpAT. Training background did not differ between groups. Programs with an OPAT/COpAT RPH were more likely to have a formal OPAT team compared to those without an OPAT/COpAT RPH (p < 0.001). OPAT/COpAT RPHs were early in their careers, with roughly half practicing < 5 years in ID, and 66.7% practicing < 5 years in OPAT/COpAT. Most OPAT/COpAT RPHs (66.7%) practiced at an academic medical center with a median full time equivalent (FTE) of 1 RPH. Most (63%) utilized a collaborative practice agreement and 81.5% shared job functions with other ID RPH roles, most commonly antimicrobial stewardship. Few (28%) OPAT/COpAT programs involved a dispensing component. The average daily census was 42 patients followed by an OPAT/COpAT RPH. There was wide variability in the types of tasks ID RPH performed in OPAT/COpAT, the three most important tasks are listed in Figure 1. OPAT Pharmacists Task Ranking by Importance There was wide variability in the types of tasks ID pharmacist performed in OPAT/COpAT. The most OPAT/COpAT pharmacists responded that adjusting medications based on lab values was in their top 3 most important clinical tasks. When ranking the top three most important tasks, selecting the initial OPAT/COpAT regimen was ranked first most often, followed by review of review of OPAT appropriateness for discharge, then adjusting medications based on lab values. Conclusion This is the largest known survey of OPAT/COpAT RPHs. RPH involvement in OPAT/COpAT in the US is an emerging trend with wide variability in program structure. Tasks performed by OPAT/COpAT RPHs varied significantly; however, OPAT/COpAT RPH respondents’ functions are largely clinical in nature. Disclosures All Authors: No reported disclosures

AbstractOutpatient parenteral antimicrobial therapy (OPAT) is a well‐established mechanism to facilitate patient discharge, lower inpatient admission cost, and decrease the risk of health care–acquired infections. Although there are numerous benefits to patients and health care institutions, OPAT is complex and not without risks. Patients may be discharged on long courses of oral antimicrobials, known as complex outpatient antimicrobial therapy (COpAT), which also requires careful monitoring and oversight. This, coupled with the need for antimicrobial stewardship across the continuum of care, positions pharmacists with infectious diseases (ID) training as crucial leaders in the field of OPAT. The development, implementation, and maintenance of these services requires the careful attention of health care personnel in discharge antimicrobial selection, continuity of care at key care transitions, implementation of optimal care bundles, provision of thorough patient education throughout the OPAT process, coordination with a multidisciplinary team including home infusion and nursing, and monitoring of program metrics to determine successes and opportunities for improvement. Ongoing support for optimal delivery of patient care will be required as OPAT practice, and health care delivery at large, continues to evolve. This involves continued advocacy for collaborative practice development, optimizing payment for nondispensatory OPAT services, and integration of effective telehealth programs. This article summarizes the need for practice expansion of ID pharmacist specialists in OPAT/COpAT management across the care continuum and best practices for establishment of these services.

Red Man Syndrome is a term used for an adverse event attributed to vancomycin infusion. Based on the presentation within white patients, the term is imprecise at best and can lead to suboptimal classification and management. Recent calls have advocated for the discontinuation of the use of this terminology. Pharmacists should take the lead in advocating for this change.