Outcomes Of Orthopedic Hardware-Related Infection Treated Via A Public Teaching Hospital Outpatient Parenteral Antimicrobial Therapy Program

BackgroundOrthopedic hardware-related infection (OHRI) is associated with high morbidity and cost with limited published data describing outpatient parenteral antimicrobial therapy (OPAT) for its treatment. This study was conducted to evaluate clinical outcomes, complications, and risk factors for treatment failure in OHRI patients treated with OPAT. MethodsElectronic medical records of adults receiving OPAT for OHRI between July 1, 2009 and March 1, 2015 were retrospectively reviewed. Demographic, medical, infection-specific, and drug-specific data were collected for each patient. Patients were categorized as cure or failure using standardized definitions. Safety was evaluated through adverse drug event and line complication monitoring; readmission rates were recorded. ResultsFifty patients with OHRI (mean age, 51.5 +/- 12.6 years; 56% male) received OPAT for a mean duration of 41.4 +/- 6.9 days. Thirty-one patients received OPAT in the presence of retained hardware-15 (48%) achieved clinical cure and 16 (52%) experienced failure; 3 patients (10%) experienced early (within 4 weeks) failure requiring unanticipated surgery. Twenty-four patients with retained hardware received oral suppressive antibiotics after OPAT until hardware removal; 3 nonadherent patients experienced failure. Nineteen patients received OPAT after hardware removal-14 (74%) achieved clinical cure and 5 (26%) experienced failure. Five patients (10%) experienced adverse drug event and 4 patients (8%) developed line complications resulting in readmission for 3 patients (6%) and alternate therapy for 4 patients (8%). ConclusionsOutpatient parenteral antimicrobial therapy is safe and effective for OHRI, especially after hardware removal. Retention of hardware and nonadherence to oral suppression were associated with failure.