Outcomes from global adult outpatient parenteral antimicrobial therapy programmes: A review of the last decade

Mackenzie, M.S.; Rae, Nikolas; Nathwani, Dilip

doi:10.1016/j.ijantimicag.2013.09.006

Cited by 78 publications

(71 citation statements)

References 62 publications

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“…Several authors have called for more uniform standards and definitions for all outcome measures with prolonged periods of follow-up [16,19,38,39]. OPAT hospital re-admission rates for patients may vary for a number of reasons, including: a differences in definitions (e.g.…”

Section: Monitoring and Outcomesmentioning

confidence: 99%

“…Whilst we know of no prospective studies comparing the outcomes of patients treated at facilities with and without structured OPAT programmes, a number of studies lend support to the view that outcomes are improved by having a structured approach [36][37][38][39]. Without such an approach, there is a real risk of underuse and overuse of antibiotics, patient non-adherence, missed antibiotic doses, loss to follow-up (sometimes with PICC lines in situ), adverse events due to lack of clinical and laboratory monitoring, and increased re-admission rates.…”

Section: Monitoring and Outcomesmentioning

confidence: 99%

See 1 more Smart Citation

The history and evolution of outpatient parenteral antibiotic therapy (OPAT)

Williams

Baker

Kind

et al. 2015

International Journal of Antimicrobial Agents

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Section: Monitoring and Outcomesmentioning

confidence: 99%

Section: Monitoring and Outcomesmentioning

confidence: 99%

The history and evolution of outpatient parenteral antibiotic therapy (OPAT)

Williams

Baker

Kind

et al. 2015

International Journal of Antimicrobial Agents

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“…Patients require a line in situ which increases their risk of IV-line-related infections and, depending on OPAT model (e.g. OPAT centre, hospital unit administration), transportation to an outpatient infusion centre [6]. The impact of emerging novel single-dose or two-dose infusion therapies on the need for such OPAT infrastructure remains to be seen.…”

mentioning

confidence: 99%

Implementing criteria-based early switch/early discharge programmes: a European perspective

Nathwani

Lawson

Dryden

et al. 2015

Clinical Microbiology and Infection

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Early switch (ES) from intravenous (IV) to oral antibiotic therapy programmes is increasingly included as a component of hospital antimicrobial stewardship initiatives that aim to optimize antimicrobial therapy while limiting toxicity and resistance. In terms of prioritizing the most cost-effective stewardship interventions, ES has been seen as a 'low-hanging fruit', which refers to selecting the most obtainable targets rather than confronting more complicated issues. Administration of highly bioavailable oral antibiotics should be considered for nearly all non-critically ill patients and has been recommended as an effective and safe strategy for over two decades. However, to accrue the most benefit from ES, it should be combined with an early discharge (ED) plan, protocol, or care pathway. Benefits of this combined approach include improved patient comfort and mobility, reduced incidence of IV-line-related adverse effects, reduced IV antimicrobial preparation time, decreased hospital stays, reduced antimicrobial purchasing and administration costs, decreased patient deconditioning, and shortened recovery times. Results from published studies document decreases in healthcare resource use and costs following implementation of ES programmes, which in most studies facilitate the opportunity for ED and ED programmes. Barriers to the implementation of these programmes include clinician misconceptions, practical considerations, organizational factors, and a striking lack of awareness of IV to oral switch guidance. These and other barriers will need to be addressed to maximize the effectiveness of ES and ED programmes. As national antimicrobial stewardship programmes dictate the inclusion of ES and ED programmes within healthcare facilities, programmes must be developed and success must be documented.

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“…The use of outpatient parenteral antimicrobial therapy (OPAT) has markedly increased in the United States and worldwide (3)(4)(5). Conditions commonly managed by OPAT include intra-abdominal infections, skin and soft-tissue infections, bone and joint infections, pneumonia, and urinary tract infections (5,6).…”

mentioning

confidence: 99%

“…Conditions commonly managed by OPAT include intra-abdominal infections, skin and soft-tissue infections, bone and joint infections, pneumonia, and urinary tract infections (5,6). Ertapenem is one of the antimicrobial agents that is highly utilized in outpatient settings for the aforementioned reasons (7).…”

mentioning

confidence: 99%

Safety and Efficacy of Long-Term Outpatient Ertapenem Therapy

Qureshi

Syed

Doi

2014

Antimicrob Agents Chemother

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Ertapenem is increasingly utilized in outpatient parenteral antimicrobial therapy (OPAT), but data regarding the efficacy and safety of long-term ertapenem therapy have been limited. We conducted a retrospective cohort study of adult patients who received outpatient ertapenem therapy at our center between 2010 and 2013. Among 306 unique patients who were discharged on ertapenem therapy, the most common indications were intra-abdominal infections (38%), followed by pneumonia (12%), bone and joint infections (11%), bloodstream infections (10%), urinary tract infections (10%), surgical site infections (5%), and skin and soft-tissue infections (4%). Of these 306 patients, 68 received regular outpatient follow-up visits at our infectious disease clinic, where the majority of patients (91%) were successfully treated with ertapenem by the end of therapy. Of the 6 patients who experienced clinical failure, 2 had adverse events leading to discontinuation of therapy and 4 required additional source control for clinical success. In addition, 2 patients had recurrent infection at 6 months.

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Outcomes from global adult outpatient parenteral antimicrobial therapy programmes: A review of the last decade

Cited by 78 publications

References 62 publications

The history and evolution of outpatient parenteral antibiotic therapy (OPAT)

The history and evolution of outpatient parenteral antibiotic therapy (OPAT)

Implementing criteria-based early switch/early discharge programmes: a European perspective

Safety and Efficacy of Long-Term Outpatient Ertapenem Therapy

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