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The impact of an outpatient parenteral antibiotic therapy (OPAT) clinic for adults with cellulitis: an interrupted time series study

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Abstract

Emergency department (ED) patients with cellulitis requiring intravenous antibiotics may be eligible for outpatient parenteral antibiotic therapy (OPAT). The primary objective was to determine whether implementation of an OPAT clinic results in decreased hospitalizations and return ED visits for patients receiving OPAT. We conducted an interrupted time series study involving adults with cellulitis presenting to two EDs and treated with intravenous antibiotics. The intervention was the OPAT clinic, which involved follow up at 48–96 h with an infectious disease physician to determine the need for ongoing intravenous antibiotics (implemented January 1, 2014). The primary outcomes were hospital admission and return ED visits within 14 days. Secondary outcomes were treatment failure (admission after initiating OPAT) and adverse peripheral line or antibiotic events. We used an interrupted time series design with segmented regression analysis over one-year pre-intervention and one-year post-intervention. 1666 patients were included. At the end of the study period, there was a non-significant 12% absolute increase in hospital admissions (95% CI − 1.6 to 25.5%; p = 0.084) relative to what would have been expected in the absence of the intervention, but a significant 40.7% absolute reduction in return ED visits (95% CI 25.6–55.9%; p < 0.001). Treatment failure rates were < 2% and adverse events were < 6% in both groups. Implementation of an OPAT clinic significantly reduced return ED visits for cellulitis, but did not reduce hospital admission rates. An ED-to-OPAT clinic model is safe, and has a low rate of treatment failures.

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Acknowledgements

The authors would like to thank the following individual for their assistance in this study: My-Linh Tran, Angela Marcantonio, and Catherine Clement.

Funding

This study was funded by a Grant from The Ottawa Hospital Academic Medical Organization (TOHAMO).

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada

    Krishan Yadav, Hans Rosenberg, Ian G. Stiell & Debra Eagles

  2. Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada

    Krishan Yadav, Monica Taljaard, Marie-Joe Nemnom, Kathryn N. Suh, Ian G. Stiell & Debra Eagles

  3. Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

    Amanda M. S. Mattice & Ryan Yip

  4. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada

    Monica Taljaard, Ian G. Stiell & Debra Eagles

  5. Department of Emergency Medicine, Health Science North Research Institute, Northern Ontario School of Medicine, Sudbury, ON, Canada

    Robert Ohle

  6. Division of Emergency Medicine, Department of Medicine, Western University, London, ON, Canada

    Justin Yan

  7. Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, ON, Canada

    Kathryn N. Suh

  8. Clinical Epidemiology Unit, F660b, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada

    Krishan Yadav

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  1. Krishan Yadav
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Contributions

KY, HR, KNS, IGS, and DE conceived and designed the study. JY and RO provided input on study design and approach. KY, KNS, IGS and DE obtained research funding. KY, AM, and RY performed screening and data abstraction. MT and MJN provided statistical expertise and oversaw data analysis. KY drafted the manuscript, and all authors contributed substantially to its revision. KY takes responsibility for the manuscript as a whole.

Corresponding author

Correspondence to Krishan Yadav.

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Conflict of interest

KY, AM, RY, HR, MT, MJN, RO, JY, KNS, IGS and DE reports no conflict of interest.

Statement of human and animal rights

This study was approved by the Ottawa Health Science Network Research Ethics Board. This study was conducted in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

For this type of study, no informed consent is required.

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Yadav, K., Mattice, A.M.S., Yip, R. et al. The impact of an outpatient parenteral antibiotic therapy (OPAT) clinic for adults with cellulitis: an interrupted time series study. Intern Emerg Med 16, 1935–1944 (2021). https://doi.org/10.1007/s11739-021-02631-0

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  • DOI: https://doi.org/10.1007/s11739-021-02631-0

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