Cai, Songlin

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) allows patients to complete extended antimicrobial treatment at home, improving quality of life and reducing healthcare costs. National guidelines outline best practices for antimicrobial administration, vascular access management, monitoring, and recommend involving an infectious disease physician and a multidisciplinary team. Evaluating adherence to these practices can identify improvement opportunities and enhance outcomes. The primary objective of this study was to assess patient outcomes related to adherence to OPAT best practices at Mayo Clinic Health System – Southwest Wisconsin (MCHS–SWWI). Secondary objectives included evaluating adherence to key process metrics and identifying associations between baseline characteristics and outcomes. Methods This retrospective cohort study included adults discharged from MCHS–SWWI on home OPAT from November 2021 to July 2024. Patients were excluded if under 18 years old or if they received OPAT in non-home settings (e.g., skilled nursing, infusion center). Data on process metrics, outcomes, and safety were collected through manual chart review. These findings were evaluated against established best practices to assess the OPAT program's adherence and determine the impact of this adherence on patient outcomes. Statistical analysis used Pearson’s chi-square tests and Wilcoxon rank sum tests to measure associations of patient characteristics with outcomes. Results A total of 164 patients were included. The MCHS-SWWI OPAT program demonstrated high adherence ( > 85%) to majority of established best practices. Successful OPAT completion occurred in 92.7% of patients, and overall incidence of adverse events and poor outcomes was generally low. Adherence to best practices was below 85% for vascular access selection (81.7%) and completion of weekly labs and vascular access care throughout the OPAT course (∼69%). Conclusion High adherence to OPAT best practices led to a generally low incidence of adverse events, treatment failures, and other unfavorable patient outcomes. The results of this study provide valuable insights to guide institutional quality improvement initiatives aimed at optimizing patient outcomes in OPAT therapy through targeted interventions. Disclosures All Authors: No reported disclosures

Background: Recent literature demonstrated a 24-hour reduction in vancomycin duration of therapy (DOT) for skin and soft tissue infections (SSTIs) with a negative methicillin-resistant staphylococcus aureus (MRSA) nasal screening versus a positive nasal screening. Objective of this study was to investigate vancomycin DOT in patients with SSTIs who received MRSA nasal polymerase chain reaction (PCR) screening versus those who did not receive MRSA nasal PCR screening. Methods: A retrospective, multi-center, cohort study was completed in admitted adult patients on vancomycin for SSTI from 01/01/2020 to 09/30/2022. Hospital policy permits any clinician to order a MRSA nasal PCR screening test for various indications, including SSTIs, pneumonia and sepsis. Results: One-hundred-fifty-one patients were included, of which 71 had MRSA nasal PCR screening tests obtained, and 80 did not. The median vancomycin DOT in patients with MRSA nasal PCR screening tests was 19.9 versus 36.7 hours ( P = .014) in patients without screening tests. Conclusion: Patients with SSTIs who receive MRSA nasal PCR screening tests have a shortened vancomycin DOT. These results contribute to current data in support of the efficacy and clinical utility of obtaining MRSA nasal PCR screening tests for SSTIs.