Infectious Disease

Community-based Parenteral Antimicrobial Treatment

Community-based parenteral antimicrobial therapy (CoPAT) is the administration of intravenous antibiotic therapy outside the hospital setting. During the past 40 years this has become a widely accepted form of therapy, and about 1 out of 1000 Americans receive it every year. CoPAT has allowed for shorter hospitalizations, resulting in lower costs of healthcare, and has even prevented hospitalization in some cases.

Cleveland Clinic has had a CoPAT program since 1979. All patients hospitalized at Cleveland Clinic require evaluation by an infectious disease staff physician before they can be discharged on CoPAT. The same staff physician follows each patient for the duration of his or her CoPAT. This practice serves an antimicrobial stewardship function at the time of transition of care from the inpatient setting to the community, and it provides continuity of care from the inpatient to the outpatient setting with appropriate follow-up when needed.

Annual CoPAT Volumes at Cleveland Clinic

2017 – 2021

CoPAT = community-based parenteral antimicrobial therapy

In the past 5 years, there have been more than 3000 CoPAT courses per year at Cleveland Clinic. CoPAT volumes were lower in 2020 because the COVID-19 pandemic resulted in fewer non-COVID hospitalizations. The total number of CoPAT courses in 2020 includes CoPAT courses at Akron General Hospital, whose infectious disease group joined Cleveland Clinic’s department in October 2020. With the easing of the COVID-19 pandemic, CoPAT volumes in 2021 were no longer artificially low.

ED Visits, Readmissions, and Death Following CoPAT

2017 – 2021

CoPAT = community-based parenteral antimicrobial therapy, ED = emergency department

Not every CoPAT course concludes uneventfully. Some patients on CoPAT require a visit to an emergency department, which is an unanticipated and unwelcome event and constitutes use of an expensive component of the healthcare system. Some patients require hospitalization.

Infection Outcomes for Patients Treated With CoPAT at Cleveland Clinic

2017– 2021

CoPAT = community-based parenteral antimicrobial therapy

Most CoPAT courses result in a successful outcome. Many “Undefined” outcomes are due to rehospitalization while still on CoPAT.