A prospective cohort study of the use of domiciliary intravenous antibiotics in bronchiectasis

Abstract

Background:We introduced domiciliary intravenous (IV) antibiotic therapy in patients with bronchiectasis to promote patient-centred domiciliary treatment instead of hospital inpatient treatment.Aim:To assess the efficacy and safety of domiciliary IV antibiotic therapy in patients with non-cystic fibrosis bronchiectasis.Methods:In this prospective study conducted over 5 years, we assessed patients’ eligibility for receiving domiciliary treatment. All patients received 14 days of IV antibiotic therapy and were monitored at baseline/day 7/day 14. We assessed the treatment outcome, morbidity, mortality and 30-day readmission rates.Results:A total of 116 patients received 196 courses of IV antibiotics. Eighty courses were delivered as inpatient treatment, 32 as early supported discharge (ESD) and 84 as domiciliary therapy. There was significant clinical and quality of life improvement in all groups, with resolution of infection in 76% in the inpatient group, 80% in the ESD group and 80% in the domiciliary group. Morbidity was recorded in 13.8% in the inpatient group, 9.4% in the ESD group and 14.2% in the domiciliary IV group. No mortality was recorded in either group. Thirty-day readmission rates were 13.8% in the inpatient group, 12.5% in the ESD group and 14.2% in the domiciliary group. Total bed days saved was 1443.Conclusion:Domiciliary IV antibiotic therapy in bronchiectasis is clinically effective and was safe in our cohort of patients.

Quality standards for the management of bronchiectasis in Italy: a national audit

“…A lower percentage of patients undergoing high-resolution CT scan and standard testing for bronchiectasis aetiology is reported in the present SIP audit in comparison to the 2012 UK audit [6]. Five more areas require particular attention, including: monitoring sputum bacteriology; promoting airway clearance taught by a specialist respiratory physiotherapist and pulmonary rehabilitation in selected patients; and developing services to allow domiciliary intravenous antibiotic treatment [12]. Possible reasons for low adherence to the quality standards include the absence of Italian and European guidelines, and lack of awareness of the disease and of the evidence base to support recommendations.…”

The Community IntraVenous Antibiotic Study (CIVAS): a mixed-methods evaluation of patient preferences for and cost-effectiveness of different service models for delivering outpatient parenteral antimicrobial therapy

“…One study looking at outpatient attendance 22 did find a higher death rate (1 patient vs. 0 patients), but this was a small study and the overall rate of side effects was lower in OPAT patients (15% vs. 18%). There also appears to be no conclusive evidence of benefit either in relation to hospital readmissions overall, or in relation to those who self-administered therapy, 42,59 although there were conflicting results for OPAT provided by nurses, with SNs 10,25,57,64 seemingly having superior results to those of GNs. 12,41 Perhaps unsurprisingly, overall there would appear to be more line-related complications in i.v.…”

“…When all models are considered, OPAT appears to produce superior results compared with inpatient treatment, a finding that is influenced by the inclusion of positive studies reporting on multiple or unspecified OPAT treatment models. When these studies are removed and specific models are considered individually, outpatient attendance appears to have a lower rate of cure or improvement, 22 and SA 59 or OPAT by a SN has a higher rate, 56,57 whereas OPAT by GN has no impact. 12,41 Results from those studies assessing the impact of treatment via OPAT specifically on lung function in patients with cystic fibrosis were either inconclusive or found no impact.…”

“…Five studies did not specify the OPAT model that was being used, 48,52,55,61,62 and three others reported combined results for multiple models. 29,49,63 Synthesis of the findings from these studies indicates that, regardless of the model used, there is little evidence of impact on either drug-related side effects or number of deaths in OPAT patients in comparison to patients receiving treatment in hospital 10,22,25,[41][42][43][56][57][58][59]64 (see Appendix 1, Tables 32 and 34). One study looking at outpatient attendance 22 did find a higher death rate (1 patient vs. 0 patients), but this was a small study and the overall rate of side effects was lower in OPAT patients (15% vs. 18%).…”

Bronchiectasis Economics: Spend Money to Save Money

“…This might then provide a basis upon which tailored interventions can be tested to not only improve bronchiectasis care but simultaneously reduce healthcare costs. As an example, Bedi et al [7] investigated home intravenous antibiotic treat-DOI: 10.1159/000490550 ment in bronchiectasis patients. They showed that this intervention was safe, resulted in less morbidity, was as efficient as hospital-based treatment, and reduced the hospitalization days significantly, thus the healthcare costs.…”