{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T08:20:02Z","timestamp":1785831602803,"version":"3.56.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"1107","license":[{"start":{"date-parts":[[2017,9,5]],"date-time":"2017-09-05T00:00:00Z","timestamp":1504569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose of the study<\/jats:title><jats:p>To measure the percentage rate and risk factors for amendment in the type, duration and setting of outpatient parenteral antimicrobial therapy (OPAT) for the treatment of cellulitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study design<\/jats:title><jats:p>A retrospective cohort study of adult patients receiving OPAT for cellulitis was performed. Treatment amendment (TA) was defined as hospital admission or change in antibiotic therapy in order to achieve clinical response. Multivariable logistic regression (MVLR) and classification and regression tree (CART) analysis were performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 307 patients enrolled. TA occurred in 36 patients (11.7%). Significant risk factors for TA on MVLR were increased age, increased Numerical Pain Scale Score (NPSS) and immunocompromise. The median OPAT duration was 7 days. Increased age, heart rate and C reactive protein were associated with treatment prolongation. CART analysis selected age &amp;lt;64.5 years, female gender and NPSS &amp;lt;2.5 in the final model, generating a low-sensitivity (27.8%), high-specificity (97.1%) decision tree.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Increased age, NPSS and immunocompromise were associated with OPAT amendment. These identified risk factors can be used to support an evidence-based approach to patient selection for OPAT in cellulitis. The CART algorithm has good specificity but lacks sensitivity and is shown to be inferior in this study to logistic regression modelling.<\/jats:p><\/jats:sec>","DOI":"10.1136\/postgradmedj-2017-134968","type":"journal-article","created":{"date-parts":[[2017,9,6]],"date-time":"2017-09-06T00:40:38Z","timestamp":1504658438000},"page":"25-31","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Risk factors for amendment in type, duration and setting of prescribed outpatient parenteral antimicrobial therapy (OPAT) for adult patients with cellulitis: a retrospective cohort study and CART analysis"],"prefix":"10.1093","volume":"94","author":[{"given":"Michael","family":"Quirke","sequence":"first","affiliation":[{"name":"Emergency Care Research Unit (ECRU),Royal College of Surgeons Ireland (RCSI) , Dublin , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma May","family":"Curran","sequence":"additional","affiliation":[{"name":"Department of Medicine, RCSI, Beaumont Hospital , Dublin , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"O\u2019Kelly","sequence":"additional","affiliation":[{"name":"Department of Statistics, Renal Medicine Unit,Beaumont Hospital , Dublin , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Moran","sequence":"additional","affiliation":[{"name":"VHI Homecare, Waverly Business Park , Dublin , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eimear","family":"Daly","sequence":"additional","affiliation":[{"name":"VHI Homecare, Waverly Business Park , Dublin , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seamus","family":"Aylward","sequence":"additional","affiliation":[{"name":"VHI Homecare, Waverly Business Park , Dublin , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerry","family":"McElvaney","sequence":"additional","affiliation":[{"name":"Department of Medicine, RCSI, Beaumont Hospital , Dublin , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abel","family":"Wakai","sequence":"additional","affiliation":[{"name":"Emergency Care Research Unit (ECRU),Royal College of Surgeons Ireland (RCSI) , Dublin , Ireland"},{"name":"Department of Emergency Medicine, Beaumont Hospital , Dublin , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2017,9,5]]},"reference":[{"key":"2023041306504449700_","first-page":"316","article-title":"A pilot cross-sectional study of patients presenting with cellulitis to emergency departments","volume":"107","author":"Quirke","year":"2014","journal-title":"Ir Med J"},{"key":"2023041306504449700_","volume-title":"Health Protection Surveillance Centre, Point prevalence survey of Hospital Acquired Infections & Antimicrobial Use in European Acute Care Hospitals","author":"Burns","year":"2012"},{"key":"2023041306504449700_","first-page":"2","article-title":"Treatment of cellulitis in hospital in the home: a systematic review","volume":"2","author":"Lasschuit","year":"2014","journal-title":"OA Dermatology"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.1093\/jac\/dkp343","article-title":"Clinical efficacy and cost-effectiveness of outpatient parenteral antibiotic therapy (OPAT): a UK perspective","volume":"64","author":"Chapman","year":"2009","journal-title":"J Antimicrob Chemother"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"f1585","DOI":"10.1136\/bmj.f1585","article-title":"Outpatient parenteral antimicrobial therapy","volume":"346","author":"Chapman","year":"2013","journal-title":"BMJ"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1093\/jac\/dks003","article-title":"Good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) in adults in the UK: a consensus statement","volume":"67","author":"Chapman","year":"2012","journal-title":"J Antimicrob Chemother"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1016\/j.idc.2009.06.008","article-title":"Pharmacokinetics and pharmacodynamics of antibacterial agents","volume":"23","author":"Levison","year":"2009","journal-title":"Infect Dis Clin North Am"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1093\/pch\/16.9.535","article-title":"Pharmacokinetics 101","volume":"16","author":"Ito","year":"2011","journal-title":"Paediatr Child Health"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1007\/s10096-013-1899-4","article-title":"Outpatient parenteral antimicrobial therapy (OPAT) in the republic of Ireland: results of a national survey","volume":"32","author":"Muldoon","year":"2013","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2023041306504449700_","author":"Jointcommisioninternational.org"},{"key":"2023041306504449700_","article-title":"An introduction to classification and regression tree (CART) analysis","author":"Lewis","year":"2000"},{"key":"2023041306504449700_","first-page":"227","article-title":"Ratios EO","volume":"19","author":"Szumilas","year":"2010","journal-title":"J Can Acad Child Adolesc Psychiatry"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1136\/bmj.38309.447975.EB","article-title":"Randomised controlled trial of intravenous antibiotic treatment for cellulitis at home compared with hospital","volume":"330","author":"Corwin","year":"2005","journal-title":"BMJ"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.ijantimicag.2011.05.008","article-title":"Factors associated with outcome and duration of therapy in outpatient parenteral antibiotic therapy (OPAT) patients with skin and soft-tissue infections","volume":"38","author":"Seaton","year":"2011","journal-title":"Int J Antimicrob Agents"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1136\/emj.2004.018143","article-title":"Emergency department management of home intravenous antibiotic therapy for cellulitis","volume":"22","author":"Donald","year":"2005","journal-title":"Emerg Med J"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1007\/s10096-016-2631-y","article-title":"OPAT for cellulitis: its benefits and the factors that predispose to longer treatment","volume":"35","author":"Zhang","year":"2016","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/j.ejim.2013.03.014","article-title":"Outpatient parenteral antibiotic therapy: principles and practice","volume":"24","author":"Seaton","year":"2013","journal-title":"Eur J Intern Med"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1017\/S1481803500014342","article-title":"Treatment failure in emergency department patients with cellulitis","volume":"7","author":"Murray","year":"2005","journal-title":"CJEM"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1111\/j.1553-2712.2009.00536.x","article-title":"Soft tissue infections and Emergency department disposition: predicting the need for inpatient admission","volume":"16","author":"Sabbaj","year":"2009","journal-title":"Acad Emerg Med"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1093\/cid\/cit920","article-title":"Prediction model for 30-day hospital readmissions among patients discharged receiving outpatient parenteral antibiotic therapy","volume":"58","author":"Allison","year":"2014","journal-title":"Clin Infect Dis"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1007\/s10096-009-0855-9","article-title":"Baseline factors predicting the duration of intravenous antibiotic therapy for cellulitis in an outpatient setting","volume":"29","author":"Lillie","year":"2010","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1093\/cid\/cis566","article-title":"Progress on developing endpoints for registrational clinical trials of community-acquired bacterial pneumonia and acute bacterial skin and skin structure infections: update from the Biomarkers Consortium of the Foundation for the National Institutes of Health","volume":"55","author":"Talbot","year":"2012","journal-title":"Clin Infect Dis"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1093\/cid\/ciw463","article-title":"Early Response in Cellulitis: A Prospective Study of Dynamics and Predictors","volume":"63","author":"Bruun","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1053\/ajem.2001.28330","article-title":"ED management of cellulitis: a review of five urban centers","volume":"19","author":"Dong","year":"2001","journal-title":"Am J Emerg Med"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1093\/jac\/dkq362","article-title":"Severity assessment of skin and soft tissue infections: cohort study of management and outcomes for hospitalized patients","volume":"66","author":"Marwick","year":"2011","journal-title":"J Antimicrob Chemother"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1097\/MEJ.0000000000000245","article-title":"The management of cellulitis in emergency departments: antibiotic-prescribing practices and adherence to practice guidelines in Ireland","volume":"23","author":"Quirke","year":"2016","journal-title":"Eur J Emerg Med"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1093\/jac\/dku517","article-title":"Outpatient parenteral antimicrobial therapy and antimicrobial stewardship: challenges and checklists","volume":"70","author":"Gilchrist","year":"2015","journal-title":"J Antimicrob Chemother"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1136\/emj.2004.019869","article-title":"Flucloxacillin alone or combined with benzylpenicillin to treat lower limb cellulitis: a randomised controlled trial","volume":"22","author":"Leman","year":"2005","journal-title":"Emerg Med J"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1097\/QCO.0000000000000142","article-title":"Alternative clinical indications for novel antibiotics licensed for skin and soft tissue infection?","volume":"28","author":"Dryden","year":"2015","journal-title":"Curr Opin Infect Dis"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"2180","DOI":"10.1056\/NEJMoa1310422","article-title":"Single-dose oritavancin in the treatment of acute bacterial skin infections","volume":"370","author":"Corey","year":"2014","journal-title":"N Engl J Med"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"2169","DOI":"10.1056\/NEJMoa1310480","article-title":"Once-weekly dalbavancin versus daily conventional therapy for skin infection","volume":"370","author":"Boucher","year":"2014","journal-title":"N Engl J Med"},{"key":"2023041306504449700_","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1016\/S1473-3099(14)70737-6","article-title":"Tedizolid for 6 days versus linezolid for 10 days for acute bacterial skin and skin-structure infections (ESTABLISH-2): a randomised, double-blind, phase 3, non-inferiority trial","volume":"14","author":"Moran","year":"2014","journal-title":"Lancet Infect Dis"}],"container-title":["Postgraduate Medical Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/pmj\/article-pdf\/94\/1107\/25\/49838481\/postgradmedj-94-25.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/pmj\/article-pdf\/94\/1107\/25\/49838481\/postgradmedj-94-25.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T13:39:30Z","timestamp":1692970770000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/pmj\/article\/94\/1107\/25\/6984171"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,9,5]]},"references-count":32,"journal-issue":{"issue":"1107","published-online":{"date-parts":[[2017,9,5]]},"published-print":{"date-parts":[[2018,1,1]]}},"URL":"https:\/\/doi.org\/10.1136\/postgradmedj-2017-134968","relation":{},"ISSN":["0032-5473","1469-0756"],"issn-type":[{"value":"0032-5473","type":"print"},{"value":"1469-0756","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2018,1]]},"published":{"date-parts":[[2017,9,5]]}}}