Outpatient parenteral antimicrobial therapy in long-term care facilities: Clinical outcomes in frail institutionalized older adults

Background Older adults residing in long-term care facilities are at high risk of infection and adverse outcomes related to hospitalization, including functional decline and loss of independence. Outpatient parenteral antimicrobial therapy (OPAT) may represent an alternative to hospital admission in this population, although data remain limited. We aimed to evaluate the safety and clinical outcomes of an OPAT program in institutionalized older adults. Methods We conducted a retrospective descriptive study including consecutive institutionalized patients aged ≥18 years enrolled in an OPAT program between January 2021 and December 2023 at a tertiary hospital in northern Spain. Demographic, clinical, microbiological, and treatment-related variables were collected. The primary outcome was clinical success. Secondary outcomes included complications and 30-day mortality. Results A total of 47 patients were included, with a median age of 82 years (Interquartile range or IQR 17). Urinary tract infections were the most frequent diagnosis (61.7%) and were mainly caused by Gram-negative bacilli, frequently ESBL-producing organisms. Ertapenem was the most commonly prescribed antibiotic. Nine patients developed catheter-related complications, all involving peripheral venous lines. Thirty-six patients successfully completed OPAT. Only four patients required hospital readmission related to OPAT, and only one death was considered related to the index infection. Conclusions OPAT may be a safe and feasible alternative to hospitalization in selected frail institutionalized older adults, allowing treatment of complex infections outside the hospital setting. Optimization of antimicrobial stewardship and vascular access strategies remains important in this population.