measuring practice and outcomes - registry outputs and

Mark GilchristConsultant Pharmacist Infectious Diseases, Imperial College Healthcare NHS TrustCo-Chair BSAC UK OPAT [email protected]

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


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


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


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


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


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



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


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


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)


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


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


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

WWW.OPATREGISTRY.COM

measuring practice and outcomes - registry outputs and

Documents