Current status in outpatient parenteral antimicrobial therapy: a practical view (original) (raw)
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The Canadian Journal of Hospital Pharmacy, 2007
Background: Outpatient parenteral antimicrobial therapy (OPAT) allows patients who require IV antimicrobials but whose condition is otherwise stable to receive therapy in the home. Objective: To describe the current practices and clinical outcomes of adult patients who received parenteral antimicrobial therapy after discharge from The Ottawa Hospital. Methods: The charts of 75 patients who received OPAT between November 1, 2003, and October 31, 2004, were reviewed to determine the indication for parenteral antibiotic therapy, the antimicrobial regimen selected, the extent of monitoring, the occurrence of complications, and the outcome of therapy. Results: Of the 75 patients whose charts were selected for review, 66 were included in the study. The most common infections treated were cellulitis (28 patients [42%]), osteomyelitis (8 patients [12%]), postsurgical wound infection (7 patients [11%]), and abscess and endocarditis (5 patients [8%] each). Cefazolin was the most commonly prescribed antimicrobial. Complications occurred in 19 (29%) of the 66 patients, and most of these related to the IV access. Overall, the majority of patients (56 or 85%) had a successful outcome. Conclusion: The majority of patients who received OPAT after discharge were treated successfully. However, the development of a formal multidisciplinary OPAT program could enhance quality of care through improvements in patient education, documentation, and monitoring.
Outpatient parenteral antimicrobial therapy as an alternative to hospitalization
International journal of clinical practice. Supplement, 1998
Outpatient parenteral antimicrobial therapy (OPAT) has evolved because of advances in antibiotics and the advent of new technology. It provides a cost-effective means of treating seriously infected patients away from hospital. Virtually any infection can be treated on an outpatient basis and several treatment programmes have been designed. Housebound patients can be visited by a nurse who will supervise administration; infusion centres, set up in a clinic or a doctor's office, provide on-hand medical staff and the benefit of a medical facility; self-administration provides autonomy for patient and family and is the least costly. Given the cost-cutting environment in which healthcare now operates worldwide, it is important that OPAT must develop its own procedures and guidelines for quality assurance. For OPAT to work away from the controlled environment of the hospital, it is essential that physicians, nurses and pharmacists adapt to new medical environments and work with the pa...
Safety and effectiveness of outpatient parenteral antimicrobial therapy in older people
Journal of Antimicrobial Chemotherapy, 2016
We analyse the safety and effectiveness of self-outpatient parenteral antimicrobial therapy (s-OPAT) in older patients. Methods: We prospectively evaluated all adults admitted to our home hospitalization unit (HHU) for s-OPAT in the period 2008-12 in whom the bacteria responsible for the infection were identified. We divided patients into three age groups: ,65, 65-79 and ≥80 years. s-OPAT was administered by patients or their caregivers using elastomeric infusion devices. Effectiveness was assessed by analysing readmissions to hospital for inadequate control of underlying infection. Safety was assessed by analysing adverse events, catheter-related complications and readmission to hospital for causes unrelated to inadequate control of underlying infection. Results: During the study period, 420 episodes of s-OPAT were registered in 351 patients: 139 (33.1%) in patients aged ,65 years, 182 (43.3%) in those aged 65-79 years and 99 (23.6%) in those aged ≥80 years. Patients aged ≥80 years had a significantly lower Barthel index. The length of stay for s-OPAT and the complete HHU stay were similar in the three groups. Older people had similar changes in antibiotic treatment and hospital readmission rates due to poor control of underlying infection but higher readmission rates due to worsening of underlying diseases than younger adults. Adverse events and catheter-related complications were similar in the three age groups. Conclusions: s-OPAT administered by patients or their caregivers using elastomeric devices was safe and effective in the treatment of infections in older people.
Enfermedades infecciosas y microbiologia clinica, 2018
Outpatient parenteral antimicrobial therapy (OPAT) programmes make it possible to start or complete intravenous antimicrobial therapy for practically any type of infection at home, provided that patient selection is appropriate for the type of OPAT programme available. Although the clinical management of infections in the home setting is comparable in many respects to that offered in conventional hospitalization (selection of antibiotics, duration of treatment, etc.), there are many aspects that are specific to this care modality. It is essential to be aware of them so that OPAT continues to be as safe and effective as inpatient care. The objective of this clinical guideline is therefore to provide evidence- and expert-based recommendations with a view to standardizing clinical practice in this care modality and contribute to a progressive increase in the number of patients who can be cared for and receive intravenous therapy in their own homes.
Outpatient parenteral antibiotic therapy (OPAT) in different countries: a comparison
International Journal of Antimicrobial Agents, 2004
Outpatient parenteral antibiotic therapy (OPAT) is considered to be a cost-effective and safe alternative treatment strategy to hospitalization. We retrospectively evaluated data regarding the demographic and treatment characteristics of patients that sought medical advice from a network of physicians performing house-call visits and who received OPAT at home during a 17-month period () in Attica, Greece. A total of 91 patients (69.2 % females) received intravenous antibiotic therapy at home during the evaluated period. The mean age [± standard deviation (SD)] of the patients was 85.3 (± 9) years. The main indications were pneumonia [46 patients (50.5 %)], urinary tract infection [25 (27.5 %)], and gastrointestinal tract infection [9 (9.9 %)]. Of the patients, 76.4 % received a beta-lactam, 17.5 % a fluoroquinolone, 15.3 % an imidazole, 8.7 % an aminoglycoside, and 5.4 % a lincosamide. The cure rate was 72.5 % and mortality was 27.5 %. The mean duration (± SD) of intravenous antibiotic treatment was 4.7 (± 3.3) days. The mean cost per patient was €637 and was comparable to the mean cost if the patient were to be hospitalized for the same infection. There was significant clinical effectiveness of OPAT at home in this mainly elderly population, at an acceptable cost.
The Journal of Antimicrobial Chemotherapy, 2007
Provision of outpatient parenteral antimicrobial therapy (OPAT) is an evolving field, facilitating discharge from hospital for selected patients with serious infections. We report on a large OPAT cohort focusing on the practice of supervised parenteral antibiotic administration in the community by patients and relatives, which we collectively term 'self-administration'. To distinguish between healthcare professional OPAT and self-administered OPAT, we have coined the terms H-OPAT and S-OPAT, respectively. Patients and methods: We analysed data on 2059 OPAT episodes collected prospectively over a 13 year time period from 1993 to 2005. Results: Clinical diagnosis, microbiology and antibiotics in this OPAT series are comparable to those previously reported. We identified no excess complications or hospital re-admissions in the S-OPAT group compared with the H-OPAT group. Conclusions: Self-administration of intravenous antimicrobial therapy, in selected patients under the supervision of a specialist team, is a safe and feasible strategy.
Infection control and hospital epidemiology, 2015
We reviewed patient discharges with outpatient parenteral antimicrobial therapy (OPAT) to determine whether outpatient parenteral antimicrobial therapy was modifiable or unnecessary at a large tertiary care children's hospital. At least one modification definitely or possibly would have been recommended for 78% of episodes. For more than 40% of episodes, outpatient parenteral antimicrobial therapy was potentially not indicated. Infect Control Hosp Epidemiol 2014;00(0):1-3.
Journal of Antimicrobial Chemotherapy, 2012
†A full list of the working group is shown in the Acknowledgements section. These good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) are an update to a previous consensus statement on OPAT in the UK published in 1998. They are based on previous national and international guidelines, but have been further developed through an extensive consultation process, and are underpinned by evidence from published literature on OPAT. They provide pragmatic guidance on the development and delivery of OPAT services, looking at all aspects of service design, care delivery, outcome monitoring and quality assurance, with the aim of ensuring that OPAT services provide high-quality, low-risk care, whatever the healthcare setting. They will provide a useful resource for teams developing new services, as well as a practical set of quality indicators for existing services.