Management of outpatient parenteral antibiotic therapy: a United States-based multi-center survey

Laila M Castellino; Christina G Rivera; Susan E Beekmann; Philip M Polgreen; Monica M Mahoney; Sara C Keller

doi:10.1017/ash.2026.10347

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Management of outpatient parenteral antibiotic therapy: a United States-based multi-center survey

Journal article

Open access

Peer reviewed

Management of outpatient parenteral antibiotic therapy: a United States-based multi-center survey

Laila M Castellino, Christina G Rivera, Susan E Beekmann, Philip M Polgreen, Monica M Mahoney and Sara C Keller

Antimicrobial stewardship & healthcare epidemiology : ASHE, Vol.6(1), e109

04/01/2026

DOI: 10.1017/ash.2026.10347

PMCID: PMC13104569

PMID: 42038603

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Abstract

Objective: Outpatient parenteral antimicrobial therapy (OPAT) programs continue to evolve with increases in multidisciplinary teams, complex oral antibiotics, long-acting injectable antimicrobials, patients with substance use disorder (SUD) and telehealth. We sought to examine how OPAT programs are currently structured and identify barriers to safe care. Design: Cross-sectional survey. Participants: Physician, pharmacist, and advanced practice providers (APP) Emerging Infections Network (EIN) members. Methods: A survey was conducted between February and March 2025 to assess OPAT structure, expansion to complex outpatient antimicrobial therapy (COpAT), and barriers to safe OPAT care. Results: Of 1639 EIN members, 622 (38%) responded; 75% reported an active role in OPAT. Oversight of patients on COpAT was reported by 59%, and mandatory ID consultation for OPAT by 59%. Eighty-one percent reported >75% of OPAT patients were followed by ID. Most patients received OPAT at home (78%) followed by post-acute care facilities. Outpatient and inpatient ID physicians were responsible for laboratory test monitoring (75% and 30% respectively), while 37% reported a multidisciplinary OPAT team and 32% reported non-specialists. Respondents cited inadequate support in data analysis, administration, information technology and financial support for clinical staff. Common challenges were lack of leadership awareness (51%), difficulty managing patients with SUD (50%) and timely access to laboratory test results (48%). Conclusions: ID physicians were commonly involved in OPAT care, with many programs expanding to COpAT. Several barriers to the safe delivery of OPAT remain, including lack of institutional support, reimbursement and poor communication between stakeholders.

Antibiotics

Antimicrobial Agents

Electronic Health Records

Infectious Diseases

Information Technology

Polls & Surveys

Administrative support

Employment

Infections

Laboratories

Laboratory tests

Nurses

Patients

Physicians

Substance use

Teaching hospitals

Teams

Details

Title: Subtitle: Management of outpatient parenteral antibiotic therapy: a United States-based multi-center survey
Creators: Laila M Castellino - The University of Texas Southwestern Medical Center
Christina G Rivera - WinnMed
Susan E Beekmann - University of Iowa
Philip M Polgreen - University of Iowa
Monica M Mahoney - Hadassah Medical Center
Sara C Keller - Johns Hopkins Medicine
Resource Type: Journal article
Publication Details: Antimicrobial stewardship & healthcare epidemiology : ASHE, Vol.6(1), e109
DOI: 10.1017/ash.2026.10347
PMID: 42038603
PMCID: PMC13104569
ISSN: 2732-494X
eISSN: 2732-494X
Publisher: Cambridge University Press
Grant note: CDC: NU50CK000574
This work was funded by CDC (cooperative agreement no. 5, grant no NU50CK000574).
Language: English
Date published: 04/01/2026
Academic Unit: Infectious Diseases; Epidemiology; Injury Prevention Research Center; Internal Medicine
Record Identifier: 9985153396402771

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