Home-Based Outpatient Parenteral Antimicrobial Therapy Associated with Poor Quality of Life

Patients receiving home-based outpatient parenteral antimicrobial therapy who are female and have comorbidities are more likely to have worse outcomes, new research finds.

Patients receiving home-based outpatient parenteral antimicrobial therapy (OPAT) have poor health outcomes, including health-related quality of life (HRQoL), according to a study recently published in Open Forum Infectious Diseases.

Several factors play a role in HRQoL outcomes in these patients, including the presence of comorbidities, female sex, race, inflammation, and bacterial infections.

“Patients receiving OPAT have a lower median health-related quality of life measure than the median American, likely related to the conditions for which they are receiving OPAT,” leading study researcher, Sara Keller, MD, MPH, MSPH, from Johns Hopkins Medicine, told Contagion®. “We need to know this information, however, to understand how interventions to improve OPAT might also improve HRQoL.”

Patients with peripherally-inserted central catheters (PICCs), tunneled central venous catheters (CVCs), or midline catheters who were receiving OPAT between March 2015 and October 2017 were enrolled (n = 251) in the study. A 10-minute telephone survey comprised of the short-form-12 (SF-12), a 12-item survey used to evaluate patient-reported health outcomes, was performed for each participant. Additionally, investigators collected participants’ demographic and clinical information by extracting these data from electronic health records (EHRs).

The primary outcome for analysis was comprised of the physical composite SF-12 (PCS-12) score and the mental composite SF-12 (MCS-12) score. In the generally healthy American population, scores on the PCS-12 and MCS-12 are a median of 50, with lower scores equating to worse health status. A multivariable linear regression analysis was performed to obtain data on predictors of PCS-12 and MCS-12.

More than half (58.1%) of participants had a Charlson Comorbidity Index score of >2, indicating the high prevalence of comorbidities in the population. In the cohort, the median PCS-12 and MCS-12 scores were 40.3 (interquartile range [IQR] 36.1-43.3) and 54.4 (IQR 44.9-60.7), respectively. In the adjusted analysis, patients with either discitis or epidural abscess were more likely to have lower PCS-12 scores (P =.01).

Additionally, female patients were more likely to have lower median MCS-12 scores compared with male patients (P =.013). In regard to race, African Americans had higher median MCS-12 scores compared with white Americans (P =.044). Higher MCS-12 scores were also observed in patients with meningitis, including community-acquired meningitis or neurosyphilis and neuroborreliosis (P =.006).

The main point researchers emphasized is the utility of these data to calculate quality-adjusted life years (QALYs), which are required to evaluate cost-effectiveness outcomes in medicine. “This is a measure that takes into account not just amount of years of life left, but also the quality of the years of life left,” Dr Keller explained. “To calculate QALYs, you need a measure of HRQoL, as calculated here.” Ultimately, the researchers note, these data generated in this study may be useful for calculating the cost-effectiveness associated with OPAT.

Treatment with OPAT likely impacts health-related quality of life, yet the researchers did not fully analyze the impact of this therapy on HRQoL during the analysis. In addition, the study may have been affected by response bias, and the analysis was not sufficiently powered to obtain MCS-12 and PCS-12 score estimates for individual disease conditions.