312-OR: OPAT Is Protective of Major Amputation following Hospitalization for Diabetic Foot Infection

Introduction & Objectives: Diabetic foot ulcers are a common complication of diabetes associated with high morbidity and mortality. It is estimated that the United States spends up to $13 billion USD each year on DFUs, with individual costs rising to $15,000 per year. Much of this expenditure has been attributed to lengthy hospital stays and inpatient care, with the need of prolonged antibiotic therapy. Outpatient antibiotic therapy (OPAT) is a service that provides intravenous antimicrobial medication in the outpatient setting and has been shown to reduce hospital stay and overall medical costs. This study aims to determine the benefit of OPAT therapy in a cohort with soft tissue and bone foot infections.

Methods: Prospective cohort study of patients hospitalized for diabetic foot infection. Patients were grouped by discharge status : OPAT program or standard of care. All patients were followed for a minimum of one year. Statistics were performed using Stata Be7. Continuous variables were reported as mean ± standard deviation and categorical variables were reported as their n(%). Odds ratios were written as O.R, followed by their associated confidence interval [CI]. Significance was determined as p≤0.05.

Results: A total of 246 patients were hospitalized with lower extremity infections in this cohort. OPAT was used in 93(38%) patients and 152(62%) with standard of care. The outcomes examined in this study included reinfection, binary wound healing, amputations, and major amputations. OPAT was found to be protective for major amputations ( OR= .21, 0.05-0.98, p=0.046). No difference was seen between reinfection ( OR=0.55, 0.28-1.09, p=0.085 ), binary wound healing ( OR=0.85, 0.50-1.45, p=0.54 or minor amputations ( OR=0.67, 0.22-1.95, p=0.45).

Conclusion: OPAT is protective against major amputation however does not reduce reinfection, improve binary wound healing, or reduce minor amputations.