950
Table 1. (Continued ) Characteristic
OPAT regimen combination therapyd β-lactam
Fluoroquinolone Aminoglycoside TMP-SMX
Location of OPAT treatment Home
Long-term acute care or skilled nursing facility Duration of OPAT course, db Vascular device for OPAT PICC/Midlinec
Tunneled central line Daily peripheral IV catheter
Clinic interactions per week of OPAT, median (IQR) Safety labs available weeklye
Gregory M. Schrank et al
Vancomycin (n=312), No. (%)
92 (29.5) 38 (12.2) 2 (0.6) 1 (0.3)
137 (43.9) 175 (56.1) 34.5 (12.5)
311 (99.7) 1 (0.3) 0 (0)
0.9 (0.6–1.5) 242 (78.0)
central catheter; TMP-SMX, trimethoprim-sulfamethoxazole; VAN, vancomycin. aBold values indicate statistical significance. bData presented as mean (standard deviation). cP≤.05 for univariate comparison of the category. dOnly receipt of combination therapy with β-lactam or fluoroquinolone used in multivariate regression model. eMissing data (VAN=1).
Data analysis
Baseline characteristics of patients receiving vancomycin and daptomycin were compared using the Student t test, the Fisher exact test, the Mann-Whitney U test, and the χ2 test as appro- priate. The primary analysis was performed using logistic regression, adjusting for 6 variables chosen a priori based on prior studies: age, CCI, location of OPAT treatment, receipt of combination therapy with either β-lactam or fluoroquinolone, baseline renal function, and availability of weekly safety labs.1,5,14,23–25,28 To measure the association between anti- microbial choice and hospital readmission and emergency room visits, 3 variables were chosen a priori for inclusion in a logistic regression model: age, CCI, and location of OPAT treat- ment.5,14,28 A sensitivity analysis including patients who died during the OPAT treatment course was completed to ensure that our results were robust to inclusion and exclusion criteria. In addition, a time-to-event analysis was completed. Patients
were censored at completion of OPAT treatment, discontinuation of vancomycin or daptomycin, or after loss to follow up and cumulative incidence curves were generated. Data were collected and analyzed using Microsoft Access 2010
software (Microsoft, Redmond, WA) and SAS version 9.3 soft- ware (SAS Institute, Cary, NC).
Ethical considerations
The Institutional Review Board of Beth Israel Deaconess Medical Center approved this study prior to data collection and analysis.
Results Study population and baseline characteristics
In total, 417 patients met inclusion criteria, including 312 (74.8%) who received vancomycin and 105 (25.2%) who received dapto- mycin (Fig. 1). We excluded 2 patients from our analysis of the primary outcome due to loss to follow-up. Baseline characteristics are summarized in Table 1. The most
common OPAT diagnoses were bone and joint infections and hardware-associated infections. The mean patient age was 60.8 years, and 38.9% of the patient cohort were female. The dis- tribution of combination regimens was similar among patients receiving daptomycin and vancomycin; the most common addi- tional agents were β-lactams and fluoroquinolones. Patients who received vancomycin were more likely to have mild renal impairment with an estimated glomerular filtration rate (eGFR) of 60–90 mL/min/1.73m2 (33.0% vs 20.0%). Patients who received vancomycin were also more likely to have recommended safety laboratory results available to the treating OPAT provider each week (78.0% vs 67.6%). Of 105 patients patients receiving daptomycin, 10 (9.5%) had an infection with vancomycin- resistant Enterococcus. After stratifying by the location of OPAT, (Supplementary
Table 1), patients receiving daptomycin therapy at home had the lowest severity of illness (CCI>1; 26.0%) compared to those receiving daptomycin therapy at a long-term acute-care or skilled nursing facility and those receiving vancomycin at either location. Most patients receiving treatment in a long-term
Daptomycin (n=105), No. (%)
28 (26.7) 11 (10.5) 0 (0)
1 (1.0) <.01
73 (69.5) 32 (30.5)
35.2 (11.6)
102 (97.1) 2 (0.2) 1 (0.1)
0.7 (0.4–1.1) 71 (67.6)
<.01 .05
Note. eGFR, estimated glomerular filtration rate; ICU, intensive care unit; IQR, interquartile range; IV, intravenous; OPAT, outpatient parenteral antibiotic therapy; PICC, peripherally inserted
.62 .05
P Valuea .50
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