measuring practice and outcomes - registry outputs and what...
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Mark GilchristConsultant Pharmacist Infectious Diseases, Imperial College Healthcare NHS TrustCo-Chair BSAC UK OPAT Initiativemark.gilchrist1@nhs.net
Measuring practice and outcomes - Registry outputs and what they mean
www.opatregistry.com
Total 37 services:England (33)Scotland (3)Northern Ireland (1)
Adult (35)Paediatric (2)
Data as of 3rd December
Data comparison comprises:
• Number of patient episodes• Number of treatment days saved• Antimicrobial agents used• Mean Length of Treatment• OPAT Outcomes • Infection Outcomes
www.opatregistry.com Data range: 2015 to 3 December 2018
15055
184833
513885111539
2870
20000
40000
60000
80000
100000
120000
140000
160000
180000
200000
Treatment Days Episodes Treatment Days Episodes Treatment Days Episodes
Scotland England Northern Ireland
UK data by Country Total 37 services:England (33)Scotland (3)Northern Ireland (1)
Adult (35) Paediatric (2)
Treatment Days Saved by PID A-L data set (n=76,964)Data range: 2015 to 3 December 2018
208
48 793
7052
993
1493
6
66 123
1876
827
83
557
717
47
3878
2502
7814
39
1518
131
5460
946
12 199
3161
29 59 252 26
03
65 415
412
250
19 109
02000400060008000
100001200014000160001800020000
Actin
omyc
osis
Appe
ndic
itis
Aspe
rgillo
sis
Bact
erae
mia
/ bl
ood
stre
am…
Bact
eria
l men
ingi
tis
Bron
chie
ctas
is
Burs
itis
Can
didi
asis
Cel
luliti
s
Cer
ebra
l abs
cess
Cho
lang
itis
Cys
tic fi
bros
is -
infe
ctiv
e…
Cyt
omeg
alov
irus
Dia
betic
foot
infe
ctio
n (n
o…
Disc
itis/v
erte
bral
…
Disc
itis/v
erte
bral
…
Early
ons
et s
epsi
s
Empy
ema
Ence
phal
itis
Endo
card
itis
Epid
ural
abs
cess
Feve
r in
early
infa
ncy
Gen
itour
inar
y
Hep
atic
abs
cess
Infe
cted
cra
niop
last
y
Infe
cted
Intra
cere
bral
…
Infe
cted
pac
ing
box
Intra
abdo
min
al a
bsce
ss
Late
ons
et s
epsi
s
Line
rela
ted
infe
ctio
n -…
Lym
e
Lym
e (N
euro
)
Lym
ph n
ode
absc
ess
Lym
phad
eniti
s
Treatment Days Saved by PID M-Z data set (n= 128,062)Data range: 2015 to 3 December 2018
1300 30
27
493
55 49
2024
3
1099
7
1127
0
1130
7
695
1252
112
932
72
1419
0
5999
1078
2
839
635 38
79
122
4797
32
3635
4 127
135
10
1548
5874
6769
51 80
6750
0
5000
10000
15000
20000
25000
MA
I (N
on-tu
berc
ulou
s…
Mal
igna
nt o
titis
exte
rna
Mas
toid
itis
Noc
ardi
osis
Orb
ital c
ellu
litis
Ost
eom
yelit
is -…
Ost
eom
yelit
is - n
on…
Ost
eom
yelit
is -…
Oth
er
Otit
is m
edia
Pelv
ic Ab
sces
s
Perio
rbita
l cel
luliti
s
Pneu
mon
ia -…
Pneu
mon
ia -
Hosp
ital…
Pros
thet
ic jo
int -
kne
e
Pros
thet
ic jo
int -
oth
er
Pros
thet
ic jo
int-
hip
Psoa
s Ab
sces
s
Pyre
xia o
f unk
now
n…
Res
pira
tory
trac
t…
Salm
onel
la
Sept
ic ar
thrit
is
Sinu
sitis
Skin
and
sof
t tis
sue…
Syph
ilis
Syph
ilis (N
euro
)
Tons
illitis
Toxic
sho
ck s
yndr
ome
Tube
rcul
osis
Urin
ary
tract
infe
ctio
n
Vasc
ular
gra
ft in
fect
ion
Vira
l inf
ectio
n
VP S
hunt
Infe
ctio
n
Wou
nd In
fect
ion
-…
Top 10 PIDs: Treatment Days Saved & Episodes Data range: 2015 to 3 December 2018
0500100015002000250030003500
0
5000
10000
15000
20000
25000
Ost
eom
yelit
is - d
iabe
ticfo
ot
Cel
luliti
s
Bron
chie
ctas
is
Pros
thet
ic jo
int -
kne
e
Oth
er
Ost
eom
yelit
is -
surg
ically
rela
ted
Ost
eom
yelit
is - n
onsu
rgica
l
Pros
thet
ic jo
int-
hip
Disc
itis/v
erte
bral
oste
omye
litis
- no
met
alw
ork
Bact
erae
mia
/ bl
ood
stre
am in
fect
ion/
Sept
icaem
ia
Treatment Days Saved Episodes
Top 10 PIDs: Treatment Days Saved & Mean Length of Treatment
Data range: 2015 to 3 December 2018
0.005.0010.0015.0020.0025.0030.0035.00
0
5000
10000
15000
20000
25000
Ost
eom
yelit
is - d
iabe
ticfo
ot
Cel
luliti
s
Bron
chie
ctas
is
Pros
thet
ic jo
int -
kne
e
Oth
er
Ost
eom
yelit
is -
surg
ically
rela
ted
Ost
eom
yelit
is - n
onsu
rgica
l
Pros
thet
ic jo
int-
hip
Disc
itis/v
erte
bral
oste
omye
litis
- no
met
alw
ork
Bact
erae
mia
/ bl
ood
stre
am in
fect
ion/
Sept
icaem
ia
Treatment Days Saved Mean LoT
Top 10 PIDs: Treatment Days Saved & Mean Length of Treatment
Data range: 2015 to 3 December 2018
2015 2016 2017 2018Osteomyelitis - diabetic foot 31.25 31.73 29.86 28.89Cellulitis 6.35 6.59 6.53 5.92Bronchiectasis 10.30 10.40 10.78 10.67Prosthetic joint - knee 28.99 29.53 26.24 29.54Other 21.74 22.03 17.89 15.51Osteomyelitis - surgically related 30.55 27.72 32.32 26.06Osteomyelitis - non surgical 27.05 24.34 27.72 27.29Prosthetic joint- hip 26.53 29.75 26.41 29.50Discitis/vertebral osteomyelitis -no metalwork 42.56 21.45 25.73 26.16Bacteraemia / blood stream infection/ Septicaemia 15.99 14.00 11.30 18.01
0.005.0010.0015.0020.0025.0030.0035.00
0
5000
10000
15000
20000
25000
Ost
eom
yelit
is -
diab
etic
foot
Cel
luliti
s
Bron
chie
ctas
is
Pros
thet
ic jo
int -
knee
Oth
er
Ost
eom
yelit
is -
surg
ically
rela
ted
Ost
eom
yelit
is - n
onsu
rgica
l
Pros
thet
ic jo
int-
hip
Disc
itis/v
erte
bral
oste
omye
litis
-…
Bact
erae
mia
/bl
ood
stre
am…
Treatment Days Saved Mean LoT
Top 10 PID by Mean Length of Treatment
Overall Mean Length of Treatment = 16.17
Data range: 2015 to 3 December 2018
55.00 53.38 52.88
41.9434.28 33.10 30.44 29.79 29.68 29.27
0.00
10.00
20.00
30.00
40.00
50.00
60.00
Noc
ardi
osis
Tube
rcul
osis
Vasc
ular
gra
ft in
fect
ion
MA
I (N
on-tu
berc
ulou
sm
ycob
acte
ria)
Pros
thet
ic jo
int -
oth
er
Otit
is m
edia
Ost
eom
yelit
is - d
iabe
ticfo
ot
Disc
itis/v
erte
bral
oste
omye
litis
-m
etal
wor
k
Mal
igna
nt o
titis
exte
rna
Ost
eom
yelit
is -
surg
ically
rela
ted
Top PIDs by CountryNorthern Ireland
Data range: 2015 to 3 December 2018
ScotlandEnglandPID
TREATMENT DAYS
Osteomyelitis - diabetic foot 19898Cellulitis 18325Bronchiectasis 14165Prosthetic joint - knee 12649Other 10694Osteomyelitis - surgically related 9964Prosthetic joint- hip 9376Osteomyelitis - non surgical 9333Discitis/vertebral osteomyelitis - no metalwork 6944Bacteraemia / blood stream infection/ Septicaemia 6396
PIDTREATMENT
DAYSProsthetic joint - other 1860
Prosthetic joint - knee 1574
Osteomyelitis - non surgical 1412
Prosthetic joint- hip 1397
Osteomyelitis - surgically related 974
Skin and soft tissue infection 770
Other 613
Discitis/vertebral osteomyelitis - no metalwork
585
Wound Infection - post surgical 571
Endocarditis 569
PIDTREATMENT
DAYSBronchiectasis 638Cerebral abscess 391Intraabdominal abscess 372Discitis/vertebral osteomyelitis -metalwork
368
Discitis/vertebral osteomyelitis -no metalwork
338
Osteomyelitis - surgically related 332Hepatic abscess 303Bacteraemia / blood stream infection/ Septicaemia
286
Osteomyelitis - non surgical 252Urinary tract infection 189
Top 10 Services by Treatment Days Saved & Episodes
Adult Paediatric2629
2223
305 332
0
500
1000
1500
2000
2500
3000
Sheffield Children'sHospital
SouthamptonChildren's Hospital
Total Treatment Days Saved Episodes Count
Data range: 2015 to 3 December 2018
41
35
3
14
31
6
10
01
4
90
96
89
17
76
62
74
02
71
91
71
28
69
80
19
70
10
14
29
3
91
7
42
8
74
0
60
4
35
3
35
6
51
1
05000
1000015000200002500030000350004000045000
Nottin
gham
Univ
Hosp
Wirra
l - A
rrow
e P
ark
RN
OH
Cald
erd
ale
Roya
lH
osp
Imperial C
olle
ge
Kir
kle
ss L
ocala
IV
Team
Univ
Colle
ge H
osp
Guy's
and S
tT
hom
as' H
osp
Bri
ghto
n &
Suss
ex
Univ
Hosp
Gre
ate
r G
lasgow
&C
lyde
Treatment Days Saved Episodes
Data range: 2015 to 3 December 2018
Top 10 Antimicrobial Agents Administered
0
1000
2000
3000
4000
5000
6000
01000020000300004000050000600007000080000
Cef
triax
one
Teico
plan
in
Erta
pene
m
Rifa
mpi
cin
Dap
tom
ycin
Pipe
raci
llin /
Tazo
bact
am
Cef
tazid
ime
Cip
roflo
xacin
Mer
open
em
Met
roni
dazo
le
Treatment Days Saved Episodes
Data range: 2015 to 3 December 2018
Top 10 Antimicrobial Agents by CountrySCOTLAND ENGLAND NORTHERN IRELAND
DRUG TREATMENT DAYS
EPISODES DRUG TREATMENT DAYS
EPISODES
DRUG TREATMENT DAYS
EPISODES
Ceftriaxone 4040 364 Ceftriaxone 67516 5233 Co-amoxiclav 1239 5Teicoplanin 2184 86 Teicoplanin 41604 1997 Ceftriaxone 923 62Daptomycin 1751 68 Ertapenem 22953 1231 Ertapenem 798 65Ertapenem 1096 55 Rifampicin 12156 326 Linezolid 288 22Dalbavancin 560 46 Daptomycin 9738 372 Piperacillin/Tazobactam 255 54Daptomycin + Rifampicin 511 11 Piperacillin/Tazo
bactam 9123 714 Ceftriaxone + Metronidazole 178 6
Ceftriaxone + Clindamycin 488 29 Ciprofloxacin 8870 264 Teicoplanin 172 12
Other 463 49 Ceftazidime 8829 575 Amikacin + Capreomycin 150 1Rifampicin 459 11 Meropenem 7722 403 Daptomycin + Linezolid +
Teicoplanin 121 1
Metronidazole 367 11 Metronidazole 4406 159 Meropenem 112 14
Data range: 2015 to 3 December 2018
Ceftriaxone administered on its own or with other agents
Ceftriaxone Combinations Treatment Days Episodes
Ceftriaxone 72479 5659Ceftriaxone + Ciprofloxacin 132 9Ceftriaxone + Ciprofloxacin + Clindamycin 104 3Ceftriaxone + Ciprofloxacin + Gentamicin 48 1Ceftriaxone + Ciprofloxacin + Rifampicin 19 1Ceftriaxone + Ciprofloxacin + Teicoplanin 28 1Ceftriaxone + Clindamycin 528 32Ceftriaxone + Daptomycin 46 2Ceftriaxone + Doxycycline 18 2Ceftriaxone + Ertapenem 20 2Ceftriaxone + Fluconazole 12 1Ceftriaxone + Fusidic Acid 80 2Ceftriaxone + Gentamicin 10 2Ceftriaxone + Levofloxacin 58 2Ceftriaxone + Linezolid 77 4Ceftriaxone + Metronidazole 626 37Ceftriaxone + Metronidazole + Teicoplanin 14 1Ceftriaxone + Rifampicin 532 20Ceftriaxone + Rifampicin + Teicoplanin 12 2Ceftriaxone + Teicoplanin 152 7
Data range: 2015 to 3 December 2018
Adverse Reactions
12
91
548
2341 48
78
326
150
40
0
50
100
150
200
250
300
350
Alle
rgy
to D
ress
ing
Blo
od d
yscr
asia
C. D
iff
Dia
rrhoe
a (a
ntib
iotic
indu
ced) Hep
atiti
s
Infe
ctio
n
Line
mig
ratio
n
Line
occ
lusi
on
Oth
er
Ras
h
Thr
ombu
s
Drug Line
Total Reactions = 919 (7.2% of all episodes)Drug Reactions = 552 (4.3% of all episodes) Line Reactions = 367 (2.9% of all episodes)
Data range: 2015 to 3 December 2018
Adverse ReactionsAdult Paediatric
95
5
4927
212
156
1443 39
81116
42
0
50
100
150
200
250
Bloo
d dy
scra
sia
C. D
iff
Dia
rrhoe
a (a
ntib
iotic
indu
ced) Hep
atiti
s
Oth
er
Ras
h
Alle
rgy
to D
ress
ing
Infe
ctio
n
Line
mig
ratio
n
Line
occ
lusio
n
Oth
er
Thro
mbu
s
Drug Line
3
5
98
15
0
2
4
6
8
10
12
14
16
Blooddyscrasia
Rash Linemigration
Lineocclusion
Other
Drug Line
Adverse Reactions by Country
Scotland = 88 (0.7% of all episodes)Northern Ireland = 14 (0.1% of all episodes) England = 817 (6.4% of all episodes)
5830
481
336
13 10
100
200
300
400
500
600
Drug Line Drug Line Drug Line
Scotland England Northern IrelandData range: 2015 to 3 December 2018
OPAT & Infection Outcomes Data range: 2015 to 3 December 2018
10583
1026305
839
8534
3221
998
0
2000
4000
6000
8000
10000
12000
Success Partial Success Indeterminate Failure Cure Improved Failure
OPAT Outcomes Infection Outcomes
OPAT & Infection Outcomes
PaediatricAdult9985
1012 304 815
7962
3184
970
0
2000
4000
6000
8000
10000
12000
Succ
ess
Parti
al S
ucce
ss
Inde
term
inat
e
Failu
re
Cur
e
Impr
oved
Failu
re
OPAT Outcomes Infection Outcomes
598
14 1 24
572
37 280
100200300400500600700
Succ
ess
Parti
al S
ucce
ss
Inde
term
inat
e
Failu
re
Cur
e
Impr
oved
Failu
re
OPAT Outcomes Infection Outcomes
NORS allows OPAT services to:- Understand UK OPAT geography- Benchmarking / learning / improving- Drive development of services - National tariff agenda- Research agenda
NORS Housekeeping:1. PID: Updated twice a year2. Antimicrobials: Upon request3. Please remember to update WTE staff
for each quarter of data entered4. Remember to maintain within T&C and
appropriate governance
NORS development and testing group
Mark Gilchrist, Imperial College Healthcare NHS Trust & BSAC OPAT co-chair
Carolyn Hemsley, Guy’s & St Thomas’ NHS Foundation Trust
Matthew Laundy, St George’s University Hospitals NHS Trust
Sarah Logan, University College Hospital
Sanjay Patel, Southampton Children’s Hospital Sue Snape, Nottingham University Hospitals NHS Trust
Claire Vallance, OPAT Greater Glasgow & ClydeTHANK
YOU
THANK YOU
THANK YOU
THANK YOU
WWW.OPATREGISTRY.COM
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