748Outpatient Parenteral Antimicrobial Therapy (OPAT) with Continuous Infusions by Elastomeric Infusion Devices in Japan, as an Effective Tool for Better Antimicrobial Stewardship

Background. Once-daily antimicrobials such as ceftriaxone are frequently used for OPAT in many countries, however those agents tend to be overused due to their convenience. Our infectious diseases team implemented the new OPAT project with continuous infusion by elastomeric infusion devices in July 2012 and has expanded it with support of homecare services. The aim of this study is to review our project at Kameda Medical Center after 22 months of operation. Methods. We retrospectively collected data about age, sex, diagnosis, organisms, types of OPAT (hospital OPAT or homecare OPAT), antimicrobials, treatment duration, bed-days saved, outcome, readmission rate and estimated cost reductions of all patients who were treated by OPAT with continuous infusions from July 2012 to April 2014. Results. 20 patients were treated by OPAT with continuous infusions by elastomeric infusion devices during the study term. The median age was 62 years (range 15-82). 15 patients (75%) were treated by hospital OPAT, and 5 (25%) treated by homecare OPAT. The most common diagnosis was osteomyelitis (35%), followed by soft tissue infection (20%). The prevalence of bacteremia was 60%. The most commonly targeted organism was methicillin-sensitive Staphylococcus aureus (55%). Cefazolin was used most frequently (60%), followed by Penicillin G (15%). The median OPAT days was 15 (range 4-29 days). Total bed days saved was 311. Peripheral inserted central catheter (PICC) was inserted for all patients and only one had to change PICC during the treatment. Only one patient discontinued OPAT due to leukocytopenia. 18 patients were cured and 2 were improved. No patient needed readmission. The estimated medical cost reduction was about 2.6 million yen, that is approximately 25 thousand US dollars. Conclusion. Our OPAT project with continuous infusions by elastomeric infusion devices successfully used first-line narrow spectrum antimicrobials for outpatients, which avoids prescribing unnecessary once-daily antimicrobials with broader spectrum. Our experience shows OPAT with continuous infusion is safe and feasible practice not only for efficient bed utilizations and medical cost savings but also for better antimicrobial stewardship. Disclosures. All authors: No reported disclosures.