Factors associated with outcome and duration of therapy in outpatient parenteral antibiotic therapy (OPAT) patients with skin and soft-tissue infections

Abstract

. Factors associated with outcome and duration of therapy in outpatient parenteral antibiotic therapy (OPAT) patients with skin and softtissue infections. International Journal of Antimicrobial Agents, Elsevier, 2011, 38 (3) This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. SSTIs were observed; 84% were treated with daily ceftriaxone and 15% with teicoplanin (three daily loading doses then three times per week). Progression of infection was observed in 2.8% of cases, inpatient management was required in 6% and significant adverse events occurred in 7.1%. Overall OPAT success was 87.1%.Female sex, diabetes and treatment with teicoplanin were independently associated with OPAT failure. A significant reduction in duration of OPAT therapy was observed over time. A longer duration of intravenous therapy was associated with meticillinresistant Staphylococcus aureus (MRSA), older age, vascular disease, a diagnosis of bursitis, and treatment with teicoplanin. Non-inpatient referrals, management via a nurse-led patient group direction, and treatment with ceftriaxone were associated with reduced duration of OPAT. For selected patients with SSTIs, OPAT was generally safe and effective, but specific patient groups were identified with more complex management pathways and poorer outcomes.

Outpatient parenteral antimicrobial therapy (OPAT) in a teaching hospital-based practice: a retrospective cohort study describing experience and evolution over 10 years

“…Whilst many previous OPAT studies, including our own [19,21,22], have been small or focused on infection-specific topics, this cohort shows that a large range of conditions as well as a complex, diverse patient group can be managed in an OPAT setting. With some exceptions [8], most OPAT studies have collected data over a time period of <3 years.…”

“…The relative frequencies of common ADRs are shown in Table 2; as some patients experienced more than one ADR reaction (for example rash and thrombocytopenia), the relative frequencies total more than 219. The relative frequency of ADRs with the most commonly used antibiotics for this OPAT service (ceftriaxone and teicoplanin) has been previously reported in the context of a SSTI treatment cohort [19].…”

Outpatient parenteral ­antimicrobial therapy (OPAT) and the general ­physician

“…The development of a patient group direction in skin and soft tissue infection, giving clinical nurse specialists the facility to implement a timely IV-tooral switch without the need for medical review, has been associated with progressive reductions in the duration of IV therapy. 13,14 While IV therapy is regarded as a standard of care in the management of many deepseated infections, the relative efficacy of IV vs oral antibiotic therapy in bone and joint infections is unknown. An Oxford-initiated UK multicentre randomised study of IV vs oral treatment is currently underway and may better define the role of OPAT in this important patient group.…”

“…12,13 Overprescribing of broadspectrum antibiotics is frequent, with such 'defensive prescribing' attributed to the precedence of treatment success in current patients at the expense of loss of effectiveness due to resistance in the future. 14 …”

Diagnosis and management of cellulitis

“…Treatment success rates are almost 90%. 25 The optimal duration of antimicrobial therapy in cellulitis remains unclear. Most cases of uncomplicated cellulitis are traditionally treated with 1-2 weeks of antimicrobial therapy.…”