Clinical benefits and costs of an outpatient parenteral antimicrobial therapy service

Bugeja, Sara Jo; Stewart, Derek; Vosper, Helen

doi:10.1016/j.sapharm.2021.01.009

Cited by 13 publications

(7 citation statements)

References 21 publications

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“…Elastomeric devices present numerous advantages, such as ease of management, since the manipulation of these devices only requires connection and disconnection from the catheter. Additionally, they are light, silent and do not require an external power supply for their functioning, allowing the complete mobility of the patient [ 9 , 10 ]. Among the limitations, the long-term use of elastomeric devices is more expensive than the one-time purchase of an electric infusion pump and the associated disposables, although continuous elastomeric pump infusion reduces the number of daily nurse visits [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Stability of Ampicillin plus Ceftriaxone Combined in Elastomeric Infusion Devices for Outpatient Parenteral Antimicrobial Therapy

et al. 2023

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Currently, ampicillin plus ceftriaxone (AC) is one of the preferred treatments for Enterococcus faecalis infective endocarditis. However, there is a lack of stability data for the combination of both drugs in elastomeric devices, so the inclusion of AC in Outpatient Parenteral Antimicrobial Therapy (OPAT) programs is challenging. The objective of the study was to determine the stability of AC in elastomeric pumps when stored at 8 ± 2 °C, 25 ± 2 °C, 30 ± 2 °C and 37 ± 2 °C using LC-MS/MS. The combination was diluted in 0.9% sodium chloride and the final concentrations were ampicillin 24 g/L plus ceftriaxone 8 g/L. Physical and chemical stability were evaluated at 12, 20, 24, 36 and 48 h after preparation. Stability was met at each time point if the percentage of intact drug was ≥90% of its respective baseline concentration and color and clearness remained unchanged. The drug combination was stable for 48 h when it was kept at 8 ± 2 °C. At 25 ± 2 °C and 30 ± 2 °C, they were stable for 24 h of storage. At 37 ± 2 °C, the stability criterion was not met at any time point. These results prove that AC could be included in OPAT programs using elastomeric infusion devices for the treatment of E. faecalis infections.

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Section: Introductionmentioning

confidence: 99%

Stability of Ampicillin plus Ceftriaxone Combined in Elastomeric Infusion Devices for Outpatient Parenteral Antimicrobial Therapy

et al. 2023

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“…OPAT has been associated with shorter lengths of stay, lower hospitalization costs, and higher patient satisfaction. [1][2][3][4][5] Despite the benefits, the lack of immediate, specialized supervision may heighten the risk of line malfunctions and incorrect dosing resulting in adverse events. With the use of OPAT expected to increase, it is important to identify risk factors associated with poor OPAT outcomes to mitigate preventable risks and better predict which patients may benefit from this therapy.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Adverse Outcomes with Outpatient Parenteral Antimicrobial Therapy

Wang

Elnakieb

Bae

et al. 2023

Preprint

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Objectives: Outpatient parenteral antimicrobial therapy (OPAT) use has increased significantly as it provides safe and reliable administration of long-term antimicrobials for severe infections. Benefits of OPAT include fewer antibiotic or line-related complications, increased patient satisfaction, shorter hospitalizations, and lower costs. Although OPAT programs carefully screen patients for eligibility and safety prior to enrollment, complications can occur. There is a paucity of studies identifying predictors of clinical outcomes in OPAT patients. Here, we seek to identify baseline predictors of OPAT outcomes utilizing machine learning methodologies. Methods: We used electronic health record data from patients treated with OPAT between February 2019 and June 2022 at a large academic tertiary care hospital in Dallas, Texas. Three primary outcomes were examined: 1) clinical improvement at 30 days without evidence of reinfection; 2) patient actively being followed at 30 days; and 3) occurrence of any adverse event while on OPAT. Potential predictors were determined a priori, including demographic and clinical characteristics, OPAT setting, intravenous line type, and antimicrobials administered. Three classifiers were used to predict each outcome: logistic regression, random forest, and extreme gradient boosting (XGBoost). Model performance was measured using AUC, F1, and accuracy scores. Results: We included 664 unique patients in the study, of whom 57% were male. At 30 days, clinical improvement was present in 78% of patients. Two-thirds of patients (67%) were actively followed at 30 days, and 30% experienced an adverse event while on OPAT. The XGBoost model performed best for predicting treatment success (average AUC = 0.873), with significant predictors including ID consultation and the use of vancomycin. The logistic regression model was best for predicting adverse outcomes (average AUC = 0.710). Risk factors for adverse outcomes included management in the home setting and the use of vancomycin, daptomycin, or piperacillin-tazobactam. Conclusion: Outcomes of patients undergoing OPAT can be predicted with the use of easily-obtainable clinical and demographic factors. Patients requiring certain antimicrobial therapies, such as vancomycin or daptomycin, may derive less benefit from early hospital discharge and OPAT.

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“…OPAT is usually defined as the outpatient or community-based management of an infection via the administration of an intravenous antimicrobial without an overnight hospital stay [ 13 ]. This healthcare tool provides multiple advantages, including significant hospital cost savings or readmission avoidance, as well as reducing the hospital dissemination of multidrug-resistant bacteria [ 14 ]. Additionally, it improves the patient’s quality of life, especially for those who suffer from repeated exacerbations because they can be treated in the comfortable environment of their home, avoiding multiple hospital admissions [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Stability Studies of Antipseudomonal Beta Lactam Agents for Outpatient Therapy

Fernández-Rubio,

Herrera-Hidalgo,

de Alarcón

et al. 2023

Pharmaceutics

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Outpatient parenteral antimicrobial therapy (OPAT) is a useful treatment strategy against Pseudomonas aeruginosa and other multidrug-resistant bacteria. However, it is hindered by the lack of stability data for the administration of antibiotics under OPAT conditions. Our objective was to investigate the stability of nine antipseudomonal and broad-spectrum beta lactam antibiotics (aztreonam, cefepime, cefiderocol, ceftazidime, ceftazidime/avibactam, ceftolozane/tazobactam, meropenem, meropenem/vaborbactam, and piperacillin/tazobactam) to allow the spread of OPAT programs. All the antibiotics were diluted in 500 mL 0.9% sodium chloride and stored at 4, 25, 32, and 37 °C for 72 h in two different devices (infusion bags and elastomeric pumps). The solutions were considered stable if the color, clearness, and pH remained unchanged and if the percentage of intact drug was ≥90%. All the antimicrobials remained stable 72 h under refrigerated conditions and at least 30 h at 25 °C. At 32 °C, all the antibiotics except for meropenem and meropenem/vaborbactam remained stable for 24 h or more. At 37 °C, only aztreonam, piperacillin/tazobactam, cefepime, cefiderocol, and ceftolozane/tazobactam were stable for at least 24 h. The stability results were the same in the two devices tested. All the antibiotics studied are actual alternatives for the treatment of antipseudomonal or multidrug-resistant infections in OPAT programs, although the temperature of the devices is crucial to ensure antibiotic stability.

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Clinical benefits and costs of an outpatient parenteral antimicrobial therapy service

Cited by 13 publications

References 21 publications

Stability of Ampicillin plus Ceftriaxone Combined in Elastomeric Infusion Devices for Outpatient Parenteral Antimicrobial Therapy

Stability of Ampicillin plus Ceftriaxone Combined in Elastomeric Infusion Devices for Outpatient Parenteral Antimicrobial Therapy

Risk Factors for Adverse Outcomes with Outpatient Parenteral Antimicrobial Therapy

Stability Studies of Antipseudomonal Beta Lactam Agents for Outpatient Therapy

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