777. Experience with Liposomal Amphotericin B in Outpatient Parenteral Antimicrobial Therapy (OPAT)

Abstract

Background. While OPAT is known to be a safe, effective, and convenient treatment strategy for patients receiving intravenous antimicrobials in the outpatient setting, the risk of adverse events (AEs) increases when high-risk medications, such as liposomal amphotericin B (L-AMB), are utilized. There is limited data available describing the use and safety of L-AMB in the OPAT setting. Methods. Electronic medical records of patients discharged from Barnes Jewish Hospital on L-AMB between January 2015 and July 2018 were retrospectively reviewed. The primary objective of this study was to describe the population of OPAT patients discharged on L-AMB and to evaluate factors associated with readmission and AEs. Univariate analysis was performed to evaluate for predictors of worse outcomes. Results. Forty-two patients (67% male, median age 50 years) were identified. The most common indications were histoplasmosis (n = 13, 31%) and aspergillosis (n = 7, 17%). The majority of patients were discharged to home (n = 35, 83%) on a median dose of 4 mg/kg L-AMB. More than half of the patients completed their anticipated course of L-AMB (n = 26, 62%), 17 without any interruption or change in therapy, while 16/42 patients required early discontinuation of therapy, 11 of which required a change in therapy. Twenty-one patients (50%) were readmitted during their L-AMB course with a median time to readmission of 10 days (IQR 4-18). While hypokalemia and AKI (increase in serum creatinine by 0.5 mg/dL or 50% from baseline) were common AEs, occurring in 62% (n = 26) and 49% (n = 20), only 5 (12%) were readmitted to the hospital due L-AMB-associated AE (hypokalemia (K < 3 mEq/L), n = 2; AKI, n = 3. Factors associated with all-cause readmission included malignancy (not readmitted 6/21 vs. readmitted 13/21, P = 0.02) and duration of therapy (median of 15 vs. 32 days in not readmitted vs. readmitted, P = 0.02). OPAT lab monitoring was performed at a median of 2 times per week. No patients required hemodialysis due to AKI. Conclusion. L-AMB is associated with significant AEs; however, these results suggest treatment is feasible in the outpatient setting with close monitoring. The majority of AEs were managed effectively as an outpatient without long-term sequelae.