Outcomes of Self-Administered Outpatient Parenteral Antibiotic Therapy in Patients with Osteomyelitis of the Foot.

The objective of this paper is to compare outcomes for patients treated with healthcare administered Outpatient Parenteral Antimicrobial Therapy (H-OPAT) versus S-OPAT (self-administered antibiotics) for the treatment of foot osteomyelitis. This was a retrospective cohort study of 202 subjects with osteomyelitis that were admitted to the hospital for moderate or severe foot infections and followed for 1 year. There were 134 subjects in the H-OPAT group and 68 in the S-OPAT group. Diabetes was prevalent in 157/202 (77.7%) subjects in the study cohort. The primary outcomes were reinfection, wound healing, time until wounds healed, amputation (minor and major), mortality, rehospitalization of the same foot, and length of stay. Reinfection was defined as infection of the same site from index procedure. S-OPAT patients were more likely to require rehospitalization (O.R = 2.10 [1.11, 3.70]) and less likely to have complete wound healing within 90 days (O.R = 0.49 [0.25, 0.96]). When Kaplan Meier survival analysis was evaluated, S-OPAT patients had longer times to heal (H-OPAT; 136.0 ± 105.2 days vs S-OPAT; 183.7 ± 118.9 days, p = 0.01. There were no differences between S-OPAT and H-OPAT for 1-year wound healing, amputation, rate of reinfection, mortality, or length of stay. Overall, S-OPAT subjects demonstrated an increased association with binary wound healing at 90 days, hospitalization, and require longer antibiotic duration.