Acute dental infections managed in an outpatient parenteral antibiotic program setting: prospective analysis and public health implications

Connors, William J; Parkins, Michael D; Holton, Donna L; Rabie, Heidi H; Figueiredo, Rafael L

Acute dental infections managed in an outpatient parenteral antibiotic program setting: prospective analysis and public health implications

dc.contributor.author	Connors, William J
dc.contributor.author	Parkins, Michael D
dc.contributor.author	Holton, Donna L
dc.contributor.author	Rabie, Heidi H
dc.contributor.author	Figueiredo, Rafael L
dc.date.accessioned	2017-03-13T22:14:12Z
dc.date.available	2017-03-13T22:14:12Z
dc.date.issued	2017
dc.description.abstract	BACKGROUND: The number of Acute Dental Infections (ADI) presenting for emergency department (ED) care are steadily increasing. Outpatient Parenteral Antibiotic Therapy (OPAT) programs are increasingly utilized as an alternative cost-effective approach to the management of serious infectious diseases but their role in the management of severe ADI is not established. This study aims to address this knowledge gap through evaluation of ADI referrals to a regional OPAT program in a large Canadian center. METHODS: All adult ED and OPAT program ADI referrals from four acute care adult hospitals in Calgary, Alberta, were quantified using ICD diagnosis codes in a regional reporting system. Citywide OPAT program referrals were prospectively enrolled over a five-month period from February to June 2014. Participants completed a questionnaire and OPAT medical records were reviewed upon completion of care. RESULTS: Of 704 adults presenting to acute care facilities with dental infections during the study period 343 (49%) were referred to OPAT for ADI treatment and 110 were included in the study. Participant mean age was 44 years, 55% were women, and a majority of participants had dental insurance (65%), had seen a dentist in the past six months (65%) and reported prior dental infections (77%), 36% reporting the current ADI as a recurrence. Median length of parenteral antibiotic therapy was 3 days, average total course of antibiotics was 15-days, with a cumulative 1326 antibiotic days over the study period. There was no difference in total duration of antibiotics between broad and narrow spectrum regimes. Conservative cost estimate of OPAT care was $120,096, a cost savings of $597,434 (83%) compared with hospitalization. CONCLUSIONS: ADI represent a common preventable cause of recurrent morbidity. Although OPAT programs may offer short-term cost savings compared with hospitalization, risks associated with extended antibiotic exposures and delayed definitive dental management must also be gauged.	en_US
dc.description.refereed	Yes	en_US
dc.identifier.citation	Connors WJ, Rabie HH, Figueiredo RL, Holton DL, Parkins MD. Acute dental infections managed in an outpatient parenteral antibiotic program setting: prospective analysis and public health implications. BMC Infectious Diseases. 2017;17(1):202.	en_US
dc.identifier.doi	10.1186/s12879-017-2303-2
dc.identifier.doi	http://dx.doi.org/10.11575/PRISM/33830
dc.identifier.uri	http://hdl.handle.net/1880/51858
dc.language.iso	en	en_US
dc.publisher	BioMed Central	en_US
dc.publisher.department	Department of Medicine, Section of Infectious Diseases	en_US
dc.publisher.faculty	Faculty of Medicine	en_US
dc.publisher.institution	Cummings School of Medicine	en_US
dc.publisher.url	https://bmcinfectdis.biomedcentral.com/	en_US
dc.rights	Attribution Non-Commercial Share-Alike 4.0 International	*
dc.rights.uri	http://creativecommons.org/licenses/by-nc-sa/4.0/	*
dc.subject	Acute dental infection	en_US
dc.subject	odontogenic infection	en_US
dc.subject	out-patient parenteral antibiotic therapy	en_US
dc.subject	OPAT	en_US
dc.subject	public health	en_US
dc.title	Acute dental infections managed in an outpatient parenteral antibiotic program setting: prospective analysis and public health implications	en_US
dc.type	journal article