Table 1.
Risk factors for OPAT failure
| Factor | Failed, n = 25 (31.3%) | Completed, n = 55 (68.7%) | Univariate analysis |
Multivariate analysis |
||||
|---|---|---|---|---|---|---|---|---|
| OR | CI | P | OR | CI | P | |||
| Comorbidity (CHF or CKD) | 14 (63.6%) | 8 (36.4%) | 7.48 | 2.52–22.21 | <0.001 | 7.39 | 1.84–29.66 | 0.005 |
| Teicoplanin | 12 (67.7%) | 6 (33.3%) | 7.54 | 2.37–23.93 | <0.001 | 8.69 | 2.01–37.47 | 0.004 |
| Specialist referral | 17 (25.8%) | 49 (74.2%) | 0.26 | 0.08–0.86 | 0.027 | 0.25 | 0.06–1.11 | 0.068 |
| Prosthetic valve | 14 (53.8%) | 12 (46.2%) | 4.90 | 1.74–13.79 | 0.003 | — | — | — |
| Median delay to intravenous start, per day (IQR) | 4 (0.5–13) | 1 (0–3) | 1.07 | 1.01–1.14 | 0.026 | — | — | — |
| Glycopeptide-indicated organism | 13 (46.4%) | 15 (53.6%) | 2.89 | 1.08–7.73 | 0.035 | — | — | — |
| Intravascular device | 8 (57.1%) | 6 (42.9%) | 3.56 | 1.08–11.68 | 0.037 | — | — | — |
| Age, per yeara, median (IQR) | 67.1 (55.3–72.2) | 59.1 (51.0–68.0) | 1.01 | 0.98–1.05 | 0.466 | — | — | — |
| Male | 15 (25.4%) | 44 (74.6%) | 0.38 | 0.13–1.06 | 0.064 | — | — | — |
| Previous IE | 4 (40.0%) | 6 (60.0%) | 1.56 | 0.40–6.01 | 0.526 | — | — | — |
| Adult congenital heart disease | 2 (28.6%) | 5 (71.4%) | 0.87 | 0.16–4.82 | 0.873 | — | — | — |
| Ischaemic heart disease | 11 (45.8%) | 13 (54.2%) | 2.54 | 0.93–6.94 | 0.069 | — | — | — |
| CKD | 7 (63.6%) | 4 (36.4%) | 4.96 | 1.30–18.95 | 0.019 | — | — | — |
| CHF | 9 (60.0%) | 6 (40.0%) | 4.59 | 1.42–14.91 | 0.011 | — | — | — |
| Aortic valve | 12 (35.3%) | 22 (64.7%) | 1.45 | 0.55–3.83 | 0.448 | — | — | — |
| Left-sided | 20 (30.8%) | 45 (69.2%) | 1.00 | 0.28–3.64 | 1.00 | — | — | — |
| Emboli | 3 (23.1%) | 10 (76.9%) | 0.64 | 0.16–2.58 | 0.533 | — | — | — |
| S. aureus | 4 (30.8%) | 9 (69.2%) | 0.97 | 0.27–3.52 | 0.9674 | — | — | — |
| Streptococcalb | 6 (17.6%) | 28 (82.4%) | 0.30 | 0.11–0.88 | 0.023 | — | — | — |
| Enterococcal | 3 (60.0%) | 2 (40.0%) | 3.61 | 0.56–23.14 | 0.175 | — | — | — |
| Median inpatient stay, per day (IQR) | 30 (21–37) | 19 (12.5–32.5) | 1.03 | 1.00–1.06 | 0.060 | — | — | — |
| Median days of inpatient antibiotics (IQR) | 26 (17–33) | 17 (12–27) | 1.02 | 0.98–1.06 | 0.314 | — | — | — |
| Surgery during this episode | 7 (31.8%) | 15 (68.2%) | 1.04 | 0.36–2.98 | 0.946 | — | — | — |
| Unable to self-administer/home administer | 13 (40.6%) | 19 (59.4%) | 2.05 | 0.78–5.37 | 0.143 | — | — | — |
| Ceftriaxonec | 8 (17.4%) | 38 (82.6%) | 0.22 | 0.08–0.66 | 0.004 | — | — | — |
| Daptomycin | 3 (27.3%) | 8 (72.7%) | 0.80 | 0.19–3.32 | 0.760 | — | — | — |
CHF, chronic heart failure; CKD, chronic kidney disease.
Percentages given are the relative percentages of each factor. Factors in bold were input into the logistic regression model with stepwise backwards selection (χ2 = 30.3, full model −2 log likelihood = 63.6, P < 0.0001); factors retained in the model (P < 0.1) are displayed in the right-hand columns. Intravascular device refers to permanent pacemakers and implantable defibrillators. Comorbidities refer to an established medical diagnosis prior to OPAT. Patients with CKD had a median glomerular filtration rate of 22 mL/min (range 5–44 mL/min). Several non-significant factors in the univariate analysis occurred in six or fewer episodes (alcohol misuse, diabetes, active cancer, cardiac-device-related endocarditis and flucloxacillin) and are not displayed for clarity. Additional microbiological causes were coagulase-negative Staphylococcus (12), culture negative (8), mixed (3), Haemophilus, Actinobacillus, Cardiobacterium, Eikinella and Kingella spp. (‘HACEK’) group (2), Rothia sp. (1), Gamella sp. (1) and unknown (1).
aP = 0.018, Mann–Whitney.
bCovariate with glycopeptide-indicated organism.
cCovariate with teicoplanin.