{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T20:40:25Z","timestamp":1791751225348,"version":"4.3.4"},"reference-count":56,"publisher":"Hamad bin Khalifa University Press (HBKU Press)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025]]},"abstract":"\n Background:<\/jats:bold>\n Gram-negative bacteremia (GNB) causes substantial morbidity, mortality, prolonged hospitalization, and readmissions worldwide. Standard practice recommends initial intravenous (IV) antibiotics, but many clinically stable patients now complete therapy through outpatient parenteral antimicrobial therapy (OPAT), which may improve antimicrobial stewardship and reduce costs. This study aims to compare clinical and economic outcomes of inpatient versus OPAT-managed GNB.\n <\/jats:p>\n \n Methods:<\/jats:bold>\n We conducted a retrospective observational cohort study of all adults with GNB treated at a 320-bed general hospital from July 2021 to July 2022. We excluded patients younger than 18 years, blood culture contaminants, and patients with Gram-positive or mixed infections. Patients were assigned to four final treatment pathways: inpatient IV only, hospital-based OPAT IV room (OPAT-IV), home-based IV therapy (Home-IV), or early oral switch. Primary outcomes were 30-day mortality and bacteremia recurrence; secondary outcomes were length of stay and treatment cost.\n <\/jats:p>\n \n Results:<\/jats:bold>\n We identified 125 patients (mean age, 56 years; 51.2% female). Most isolates originated from urinary (54.4%) or intra-abdominal (23%) sources. Pan-sensitive organisms accounted for 57.6% of cases; extended-spectrum \u03b2-lactamase producers, 35.2%; and multidrug-resistant organisms, 7.2%. Thirty-seven patients (29.6%) completed IV therapy as inpatients, 16 (12.8%) in OPAT-IV, 13 (10.4%) in Home-IV, and 59 (47%) were discharged on oral antibiotics. Nine deaths (24.3%) occurred in the inpatient group and one (7.7%) in Home-IV; no deaths occurred in OPAT-IV or oral-therapy groups. Readmissions within 90 days were uncommon (\u22647.7% across groups). Mean antibiotic durations were 13.0 days (inpatient), 11.3 days (OPAT-IV), 10.6 days (Home-IV), and 7.7 days (oral). OPAT pathways shortened hospital stays and reduced drug and bed-day costs.\n <\/jats:p>\n \n Conclusion:<\/jats:bold>\n OPAT provided safe, effective treatment for selected patients with GNB, lowering mortality, shortening length of stay, and reducing costs compared with continued inpatient care. Careful patient selection and early IV-to-oral transition can maximize these benefits while maintaining favorable clinical outcomes.\n <\/jats:p>","DOI":"10.5339\/qmj.2025.108","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T05:30:23Z","timestamp":1765344623000},"source":"Crossref","is-referenced-by-count":2,"title":["Clinical outcome and cost of intravenous, OPAT, and oral treatment of Gram-negative bacteremia"],"prefix":"10.5339","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5141-6861","authenticated-orcid":true,"given":"Mas","family":"Chaponda","sequence":"first","affiliation":[{"name":"Hamad Medical Corporation, Doha, Qatar*Correspondance: Mas Chaponda mchaponda@hamad.qa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farah","family":"Maher","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation, Doha, Qatar*Correspondance: Mas Chaponda mchaponda@hamad.qa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Daghfal","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation, Doha, Qatar*Correspondance: Mas Chaponda mchaponda@hamad.qa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adila","family":"Shaukat","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation, Doha, Qatar*Correspondance: Mas Chaponda mchaponda@hamad.qa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walid","family":"Al-Wali","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation, Doha, Qatar*Correspondance: Mas Chaponda mchaponda@hamad.qa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manaf Kadhim","family":"Hashim Al-Obaidi","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation, Doha, Qatar*Correspondance: Mas Chaponda mchaponda@hamad.qa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muna","family":"Al Maslamani","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation, Doha, Qatar*Correspondance: Mas Chaponda mchaponda@hamad.qa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3277","reference":[{"issue":"(7):","key":"B1","series-title":"Clin Infect Dis","first-page":"1091\u20138","article-title":"Seven versus 14 days of antibiotic therapy for uncomplicated Gram-negative bacteremia: a noninferiority randomized controlled trial","volume":"69","author":"Yahav\n \nD","year":"2019"},{"issue":"(3):","key":"B2","series-title":"Indian J Pediatr","first-page":"246\u201351","article-title":"Seven versus ten days antibiotics course for acute pyogenic meningitis in children: a randomized controlled trial","volume":"88","author":"Vaswani\n \nND","year":"2021"},{"issue":"(4):","key":"B3","series-title":"Clin Microbiol Infect","first-page":"492\u20138","article-title":"Switch to oral antibiotics in Gram-negative bacteraemia: a randomized, open-label, clinical trial","volume":"30","author":"Omrani\n \nAS","year":"2024"},{"issue":"Suppl 2:","key":"B4","series-title":"Clin Infect Dis","first-page":"S198\u2013208","article-title":"Outpatient parenteral antimicrobial therapy today","volume":"51","author":"Paladino\n \nJA","year":"2010"},{"issue":"(3):","key":"B5","series-title":"Int J Antimicrob Agents","first-page":"307\u201312","article-title":"The history and evolution of outpatient parenteral antibiotic therapy (OPAT)","volume":"46","author":"Williams\n \nDN","year":"2015"},{"issue":"(2A):","key":"B6","series-title":"Am J Med","first-page":"1\u20132","article-title":"Outpatient use of intravenous antibiotics. Introduction","volume":"97","author":"Poretz\n \nDM","year":"1994"},{"issue":"(2):","key":"B7","series-title":"Open Forum Infect Dis","first-page":"ofab629","article-title":"A novel program to provide drug recovery assistance and outpatient parenteral antibiotic therapy in people who inject drugs","volume":"9","author":"Gelman\n \nSS","year":"2021"},{"issue":"(12):","key":"B8","series-title":"Infect Control Hosp Epidemiol","first-page":"1445\u201350","article-title":"Cost minimization analysis of outpatient parenteral\/oral antibiotic therapy at a trauma hospital: public health system","volume":"42","author":"Loesch\n \nGH","year":"2021"},{"key":"B9","series-title":"Front Pharmacol","first-page":"713882","article-title":"Applicability of quality indicators for appropriate antibiotic use in outpatient parenteral antimicrobial therapy (OPAT): a point prevalence survey","volume":"12","author":"March-Lopez\n \nP","year":"2021"},{"issue":"(6):","key":"B10","series-title":"J Infect","first-page":"644\u20139","article-title":"Clinical predictors of outcome in patients with infective endocarditis receiving outpatient parenteral antibiotic therapy (OPAT)","volume":"83","author":"Durojaiye\n \nOC","year":"2021"},{"issue":"(5):","key":"B11","series-title":"Open Forum Infect Dis","first-page":"ofy089","article-title":"A comparison of Cefazolin versus Ceftriaxone for the treatment of methicillin-susceptible Staphylococcus aureus bacteremia in a Tertiary Care VA Medical Center","volume":"5","author":"Carr\n \nDR","year":"2018"},{"issue":"(12):","key":"B12","series-title":"N Engl J Med","first-page":"829\u201338","article-title":"Outpatient parenteral antimicrobial-drug therapy","volume":"337","author":"Gilbert\n \nDN","year":"1997"},{"issue":"(3):","key":"B13","series-title":"Int J Antimicrob Agents","first-page":"106911","article-title":"Risk of venous thromboembolism in outpatient parenteral antimicrobial therapy (OPAT): a systematic review and meta-analysis","volume":"62","author":"Durojaiye\n \nOC","year":"2023"},{"issue":"(4):","key":"B14","series-title":"Rev Esp Quimioter","first-page":"370\u20137","article-title":"Efficacy and safety of outpatient parenteral antibiotic therapy in patients with infective endocarditis: a meta-analysis","volume":"35","author":"Wen\n \nW","year":"2022"},{"key":"B15","series-title":"Int J Infect Dis","first-page":"172\u20136","article-title":"Safety and clinical outcomes of outpatient parenteral antibiotic therapy for infective endocarditis in Christchurch, New Zealand: a retrospective cohort study","volume":"134","author":"Campbell\n \nPO","year":"2023"},{"issue":"(11):","key":"B16","series-title":"Ann Pharmacother","first-page":"1329\u201337","article-title":"Impact of a multidisciplinary team review of potential outpatient parenteral antimicrobial therapy prior to discharge from an academic medical center","volume":"45","author":"Heintz\n \nBH","year":"2011"},{"issue":"(5):","key":"B17","series-title":"Intern Med J","first-page":"880\u20134","article-title":"Telling the difference and the telling differences between hospital in the home and outpatient parenteral antibiotic therapy","volume":"52","author":"Montalto\n \nM","year":"2022"},{"issue":"(1):","key":"B18","series-title":"Hosp Pharm","first-page":"17\u20139","article-title":"Inpatient antibiotic costs associated with switching from vancomycin to daptomycin for outpatient parenteral antibiotic therapy","volume":"57","author":"Beardsley\n \nJ","year":"2022"},{"issue":"(7):","key":"B19","series-title":"Eur J Intern Med","first-page":"617\u201323","article-title":"Outpatient parenteral antibiotic therapy: principles and practice","volume":"24","author":"Seaton\n \nRA","year":"2013"},{"issue":"(1):","key":"B20","series-title":"Int J Antimicrob Agents","first-page":"7\u201316","article-title":"Outcomes from global adult outpatient parenteral antimicrobial therapy programmes: a review of the last decade","volume":"43","author":"MacKenzie\n \nM","year":"2014"},{"issue":"(1):","key":"B21","series-title":"Antimicrob Steward Healthc Epidemiol","first-page":"e36","article-title":"Rate of broad-spectrum antibiotic overuse in patients receiving outpatient parenteral antibiotic therapy (OPAT)","volume":"1","author":"Brenon\n \nJR","year":"2021"},{"issue":"(12):","key":"B22","series-title":"Curr Infect Dis Rep","first-page":"24","article-title":"Recent updates in antimicrobial stewardship in outpatient parenteral antimicrobial therapy","volume":"23","author":"Mahoney\n \nMV","year":"2021"},{"issue":"(12):","key":"B23","series-title":"Open Forum Infect Dis","first-page":"ofz496","article-title":"Evaluation of inpatient antimicrobial regimens for readmitted outpatient parenteral antimicrobial therapy patients receiving daptomycin or ertapenem for ease of administration","volume":"6","author":"Britt\n \nRS","year":"2019"},{"issue":"(2):","key":"B24","series-title":"J Pharmacol Pharmacother","first-page":"83\u20137","article-title":"Switch over from intravenous to oral therapy: a concise overview","volume":"5","author":"Cyriac\n \nJM","year":"2014"},{"issue":"(21):","key":"B25","series-title":"N Engl J Med","first-page":"1996\u20132005","article-title":"Trial of short-course antimicrobial therapy for intraabdominal infection","volume":"372","author":"Sawyer\n \nRG","year":"2015"},{"issue":"(4):","key":"B26","series-title":"J Antimicrob Chemother","first-page":"601\u20136","article-title":"Early switch from intravenous to oral antibiotics: guidelines and implementation in a large teaching hospital","volume":"43","author":"Sevinc\n \nF","year":"1999"},{"issue":"(2):","key":"B27","series-title":"JAC Antimicrob Resist","first-page":"dlz026","article-title":"Updated good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) in adults and children in the UK","volume":"1","author":"Chapman\n \nALN","year":"2019"},{"issue":"(6):","key":"B28","series-title":"Open Forum Infect Dis","first-page":"ofaa205","article-title":"Perspectives of patients on outpatient parenteral antimicrobial therapy: experiences and adherence","volume":"7","author":"Hamad\n \nY","year":"2020"},{"issue":"(7):","key":"B1","series-title":"Clin Infect Dis","first-page":"1091\u20138","article-title":"Seven versus 14 days of antibiotic therapy for uncomplicated Gram-negative bacteremia: a noninferiority randomized controlled trial","volume":"69","author":"Yahav\n \nD","year":"2019"},{"issue":"(3):","key":"B2","series-title":"Indian J Pediatr","first-page":"246\u201351","article-title":"Seven versus ten days antibiotics course for acute pyogenic meningitis in children: a randomized controlled trial","volume":"88","author":"Vaswani\n \nND","year":"2021"},{"issue":"(4):","key":"B3","series-title":"Clin Microbiol Infect","first-page":"492\u20138","article-title":"Switch to oral antibiotics in Gram-negative bacteraemia: a randomized, open-label, clinical trial","volume":"30","author":"Omrani\n \nAS","year":"2024"},{"issue":"Suppl 2:","key":"B4","series-title":"Clin Infect Dis","first-page":"S198\u2013208","article-title":"Outpatient parenteral antimicrobial therapy today","volume":"51","author":"Paladino\n \nJA","year":"2010"},{"issue":"(3):","key":"B5","series-title":"Int J Antimicrob Agents","first-page":"307\u201312","article-title":"The history and evolution of outpatient parenteral antibiotic therapy (OPAT)","volume":"46","author":"Williams\n \nDN","year":"2015"},{"issue":"(2A):","key":"B6","series-title":"Am J Med","first-page":"1\u20132","article-title":"Outpatient use of intravenous antibiotics. Introduction","volume":"97","author":"Poretz\n \nDM","year":"1994"},{"issue":"(2):","key":"B7","series-title":"Open Forum Infect Dis","first-page":"ofab629","article-title":"A novel program to provide drug recovery assistance and outpatient parenteral antibiotic therapy in people who inject drugs","volume":"9","author":"Gelman\n \nSS","year":"2021"},{"issue":"(12):","key":"B8","series-title":"Infect Control Hosp Epidemiol","first-page":"1445\u201350","article-title":"Cost minimization analysis of outpatient parenteral\/oral antibiotic therapy at a trauma hospital: public health system","volume":"42","author":"Loesch\n \nGH","year":"2021"},{"key":"B9","series-title":"Front Pharmacol","first-page":"713882","article-title":"Applicability of quality indicators for appropriate antibiotic use in outpatient parenteral antimicrobial therapy (OPAT): a point prevalence survey","volume":"12","author":"March-Lopez\n \nP","year":"2021"},{"issue":"(6):","key":"B10","series-title":"J Infect","first-page":"644\u20139","article-title":"Clinical predictors of outcome in patients with infective endocarditis receiving outpatient parenteral antibiotic therapy (OPAT)","volume":"83","author":"Durojaiye\n \nOC","year":"2021"},{"issue":"(5):","key":"B11","series-title":"Open Forum Infect Dis","first-page":"ofy089","article-title":"A comparison of Cefazolin versus Ceftriaxone for the treatment of methicillin-susceptible Staphylococcus aureus bacteremia in a Tertiary Care VA Medical Center","volume":"5","author":"Carr\n \nDR","year":"2018"},{"issue":"(12):","key":"B12","series-title":"N Engl J Med","first-page":"829\u201338","article-title":"Outpatient parenteral antimicrobial-drug therapy","volume":"337","author":"Gilbert\n \nDN","year":"1997"},{"issue":"(3):","key":"B13","series-title":"Int J Antimicrob Agents","first-page":"106911","article-title":"Risk of venous thromboembolism in outpatient parenteral antimicrobial therapy (OPAT): a systematic review and meta-analysis","volume":"62","author":"Durojaiye\n \nOC","year":"2023"},{"issue":"(4):","key":"B14","series-title":"Rev Esp Quimioter","first-page":"370\u20137","article-title":"Efficacy and safety of outpatient parenteral antibiotic therapy in patients with infective endocarditis: a meta-analysis","volume":"35","author":"Wen\n \nW","year":"2022"},{"key":"B15","series-title":"Int J Infect Dis","first-page":"172\u20136","article-title":"Safety and clinical outcomes of outpatient parenteral antibiotic therapy for infective endocarditis in Christchurch, New Zealand: a retrospective cohort study","volume":"134","author":"Campbell\n \nPO","year":"2023"},{"issue":"(11):","key":"B16","series-title":"Ann Pharmacother","first-page":"1329\u201337","article-title":"Impact of a multidisciplinary team review of potential outpatient parenteral antimicrobial therapy prior to discharge from an academic medical center","volume":"45","author":"Heintz\n \nBH","year":"2011"},{"issue":"(5):","key":"B17","series-title":"Intern Med J","first-page":"880\u20134","article-title":"Telling the difference and the telling differences between hospital in the home and outpatient parenteral antibiotic therapy","volume":"52","author":"Montalto\n \nM","year":"2022"},{"issue":"(1):","key":"B18","series-title":"Hosp Pharm","first-page":"17\u20139","article-title":"Inpatient antibiotic costs associated with switching from vancomycin to daptomycin for outpatient parenteral antibiotic therapy","volume":"57","author":"Beardsley\n \nJ","year":"2022"},{"issue":"(7):","key":"B19","series-title":"Eur J Intern Med","first-page":"617\u201323","article-title":"Outpatient parenteral antibiotic therapy: principles and practice","volume":"24","author":"Seaton\n \nRA","year":"2013"},{"issue":"(1):","key":"B20","series-title":"Int J Antimicrob Agents","first-page":"7\u201316","article-title":"Outcomes from global adult outpatient parenteral antimicrobial therapy 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\nRS","year":"2019"},{"issue":"(2):","key":"B24","series-title":"J Pharmacol Pharmacother","first-page":"83\u20137","article-title":"Switch over from intravenous to oral therapy: a concise overview","volume":"5","author":"Cyriac\n \nJM","year":"2014"},{"issue":"(21):","key":"B25","series-title":"N Engl J Med","first-page":"1996\u20132005","article-title":"Trial of short-course antimicrobial therapy for intraabdominal infection","volume":"372","author":"Sawyer\n \nRG","year":"2015"},{"issue":"(4):","key":"B26","series-title":"J Antimicrob Chemother","first-page":"601\u20136","article-title":"Early switch from intravenous to oral antibiotics: guidelines and implementation in a large teaching hospital","volume":"43","author":"Sevinc\n \nF","year":"1999"},{"issue":"(2):","key":"B27","series-title":"JAC Antimicrob Resist","first-page":"dlz026","article-title":"Updated good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) in adults and children in the 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