- ISSN: 0253-8253
- E-ISSN: 2227-0426
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oa Clinical outcome and cost of intravenous, OPAT, and oral treatment of Gram-negative bacteremia
- المصدر: Qatar Medical Journal, Volume 2025, Issue 4, ديسمبر ٢٠٢٥, 108
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- ٢٧ مارس ٢٠٢٥
- ١٤ سبتمبر ٢٠٢٥
- ١٠ ديسمبر ٢٠٢٥
Background: Gram-negative bacteremia (GNB) causes substantial morbidity, mortality, prolonged hospitalization, and readmissions worldwide. Standard practice recommends initial intravenous (IV) antibiotics, but many clinically stable patients now complete therapy through outpatient parenteral antimicrobial therapy (OPAT), which may improve antimicrobial stewardship and reduce costs. This study aims to compare clinical and economic outcomes of inpatient versus OPAT-managed GNB.
Methods: We conducted a retrospective observational cohort study of all adults with GNB treated at a 320-bed general hospital from July 2021 to July 2022. We excluded patients younger than 18 years, blood culture contaminants, and patients with Gram-positive or mixed infections. Patients were assigned to four final treatment pathways: inpatient IV only, hospital-based OPAT IV room (OPAT-IV), home-based IV therapy (Home-IV), or early oral switch. Primary outcomes were 30-day mortality and bacteremia recurrence; secondary outcomes were length of stay and treatment cost.
Results: We identified 125 patients (mean age, 56 years; 51.2% female). Most isolates originated from urinary (54.4%) or intra-abdominal (23%) sources. Pan-sensitive organisms accounted for 57.6% of cases; extended-spectrum β-lactamase producers, 35.2%; and multidrug-resistant organisms, 7.2%. Thirty-seven patients (29.6%) completed IV therapy as inpatients, 16 (12.8%) in OPAT-IV, 13 (10.4%) in Home-IV, and 59 (47%) were discharged on oral antibiotics. Nine deaths (24.3%) occurred in the inpatient group and one (7.7%) in Home-IV; no deaths occurred in OPAT-IV or oral-therapy groups. Readmissions within 90 days were uncommon (≤7.7% across groups). Mean antibiotic durations were 13.0 days (inpatient), 11.3 days (OPAT-IV), 10.6 days (Home-IV), and 7.7 days (oral). OPAT pathways shortened hospital stays and reduced drug and bed-day costs.
Conclusion: OPAT provided safe, effective treatment for selected patients with GNB, lowering mortality, shortening length of stay, and reducing costs compared with continued inpatient care. Careful patient selection and early IV-to-oral transition can maximize these benefits while maintaining favorable clinical outcomes.
