Good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) in adults in the UK: a consensus statement

Abstract

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.

Risk Factors for Failure of OPAT (Outpatient Parenteral Antimicrobial Therapy) in Veterans with Staphylococcus aureus Bacteremia

“…This is an important treatment question as SAB is associated with a high cost burden on health care systems and is associated with considerable morbidity and mortality [2,4]. We used broad criteria for treatment failure, which are consistent with definitions outlined in previous studies, current BSAC (British Society for Antimicrobial Chemotherapy) best practice recommendations, and IDSA (Infectious Diseases Society of America) guidelines for OPAT [3][4][5]8]. While these criteria likely overestimated the number of treatment failures in our study, the failure rate of 35.6% was similar to previous OPAT studies evaluating patients with SAB or SAB/IE (range 13-31%) [4,5].…”

Outpatient parenteral ­antimicrobial therapy (OPAT) and the general ­physician

“…24 It is recommended that OPAT services systematically record adverse outcomes for quality assurance purposes. 6 Many (but not all) OPAT models make use of indwelling intravascular access devices (Table 1). These are associated with line infections (at a rate of 0-3 per 1,000 OPAT patient days in published cohorts), while other line events, such as thrombosis and mechanical and chemical phlebitis, occur at higher rates (0.5-5 per 100 OPAT patient days).…”

“…Within the OPAT programme, antimicrobial stewardship principles are similarly important, minimising unnecessarily prolonged IV therapy, promoting early switching from IV to oral treatment and, whenever possible, simplification of antimicrobials to the narrowest spectrum possible. 6 It is therefore essential that every patient undergoing OPAT has an antibiotic plan and that the plan is reviewed regularly and adapted as circumstances evolve. 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.…”

“…The term antibiotic stewardship has been adopted widely to encompass initiatives that promote the responsible use of antibiotics, with the goal of preserving their future effectiveness and safeguarding public health. [4][5][6][7] The physician may perceive the concept of stewardship as patronising or insulting and a threat to clinical freedom; nonetheless, physicians in the USA have recently called for mandatory implementation of antibiotic stewardship backed by legislation. 8 This article sets out the case for antibiotic stewardship and describes commonly used stewardship strategies and the evidence supporting their effectiveness.…”

Outpatient parenteral antimicrobial therapy in a changing NHS: challenges and opportunities

“…Complications may result from the underlying infection itself, other co-morbidity, the antimicrobial therapy or the intravenous line. In light of the recent expansion of OPAT in the hospital and community settings, a new set of national OPAT practice guidelines was published earlier this year 7 as part of a larger national OPAT project coordinated by the British Society for Antimicrobial Chemotherapy (BSAC). 8 These good practice recommendations were developed through expert opinion from a wide range of stakeholders, supported by a thorough literature review, and national consultation.…”