Factors associated with all-cause 60-day readmission in patients with end-stage renal disease on hemodialysis discharged on outpatient parenteral antimicrobial therapy.

PURPOSE: Outpatient parenteral antimicrobial therapy (OPAT) is standard of care in patients who require intravenous antibiotics after hospitalization. There is a lack of data on OPAT in patients with end-stage renal disease on hemodialysis. This study characterized hemodialysis patients discharged on OPAT and identified factors associated with all-cause 60-day hospital readmission.  .

METHODS

This institutional review board-approved retrospective cohort study included hemodialysis patients 18 years of age or older who were discharged from January 2020 to August 2022 with at least 1 week of OPAT. Enrolled patients were divided into 2 groups depending on their 60-day readmission status (ie, readmitted and nonreadmitted) and compared to identify risk factors associated with readmission. Treatment success, adverse event (ADE) rates, and transition-of-care process measures were also assessed.

RESULTS

A total of 162 patients were included in the study, with 81 patients in each group. The most common indication for OPAT was bloodstream infection (n = 83, 51%). The median time to first readmission was 24 days (interquartile range, 11-45 days). After adjusting for confounders, nonreadmitted patients were more likely to have a pharmacist infection treatment plan note before discharge (adjusted odds ratio [aOR], 0.195; 95% confidence interval [CI], 0.039-0.977) and to have attended infectious disease (ID) follow-up appointments (aOR, 0.337; 95% CI, 0.161-0.705). Female sex was associated with increased risk of all-cause 60-day readmission (aOR, 3.352; 95% CI,  1.738-6.467; P < 0.001). The rate of changes in OPAT after discharge, the number of reported ADEs, and the number of emergency department visits were all significantly higher in the readmitted group.

CONCLUSION

This study suggests that pharmacist-led education, attending follow-up ID appointments, and male sex are associated with reduced risk of all-cause 60-day readmission in hemodialysis patients.  .