Outpatient ertapenem therapy in an ESBL-high-prevalence area: an efficacy, safety, and cost study

Ortiz-Álvarez, Arturo; Delgado-Ramírez, Mónica A; M, Cuevas-Zuñiga; T, Hernández-Carrera; Barrón, David Moncada; Zapata, Daniel; Vázquez, Rafael Ricardo Valdez; Ramírez-Hinojosa, Juan Pablo; Rodríguez-Zulueta, Ana Patricia

doi:10.2147/idr.s173468

Cited by 6 publications

(12 citation statements)

References 21 publications

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“…In our study, OPAT was used most frequently for UTI, and E coli was found to be the most frequent causative agent. Similar to our study, the most common diagnosis was reported as UTI by Ortiz‐Alvarez et al 11 In many studies, the diagnoses of UTI and BJI were found to be the most frequent diagnoses of the patients who were treated in OPAT units 12 . Although UTI was the most prevalent diagnosis, the total number of saved BD was higher in patients with BJI.…”

Section: Discussionsupporting

confidence: 88%

Efficacy and cost‐effectivity analysis of outpatient parenteral antimicrobial therapy unit in infectious disease clinical practices: Turkey perspective

Baştuğ

Öksüz

Kazancıoğlu

et al. 2021

Int J Clinical Practice

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Background Outpatient parenteral antimicrobial treatment (OPAT) has become a common treatment modality in developed countries. OPAT units are not widespread in Turkey, and their cost‐effectivity analysis has not been studied, yet. Aims To analyze the clinical efficacy and cost‐effectiveness of the OPAT unit, based on a 1000‐bed teaching hospital. Methods The records of patients, who were treated between October 2013 and December 2017, in an OPAT unit of a tertiary hospital in Ankara, were obtained retrospectively. The cost that would arise if the patients were hospitalized for the same treatment period with the same diagnosis was calculated and compared with the actual treatment cost of the patients in the OPAT unit. Results A total of 594 patients who received antimicrobial treatment at the OPAT unit were enrolled. The mean age of the patients was 55.39 ± 16.37 years and 313 (52.7%) were males. Based on the end‐of‐treatment goals, 98.5% of the patients reached the treatment goal. An indirect cost analysis revealed that the OPAT unit was 487.625 94 TL/129.008 78 $ less costly than inpatient parenteral antibiotic treatment. In other words, OPAT cost was 75% of the equivalent inpatient costs. It was also determined that a total of 7078 bed days and 11.9 bed days per person were saved. Conclusions OPAT units should be expanded increasingly in Turkey. The evaluation together with the health care system conditions in Turkey revealed that the OPAT program is safe, effective, and cost‐efficient.

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Section: Discussionsupporting

confidence: 88%

Efficacy and cost‐effectivity analysis of outpatient parenteral antimicrobial therapy unit in infectious disease clinical practices: Turkey perspective

Baştuğ

Öksüz

Kazancıoğlu

et al. 2021

Int J Clinical Practice

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“…Our relapse and reinfection rates (32.6% and 17.9% respectively) were much higher than those in two other studies that reported relapse rates between 15% and 22% and reinfection rates 5.5% and 18% in different patients groups. [22][23][24]26 This Turkey. 15,16 Ertapenem resistance in urinary pathogens in Turkey is reported to range between 5.3% and 14.8%.…”

Section: Discussionmentioning

confidence: 99%

“…21 The use of ertapenem for OPAT was reported earlier in cUTIs with microbiologic eradication rates between 54.1% and 90% and with higher rates (92% and 96%) of clinical success. [22][23][24][25][26] OPAT for UTIs is a practical way of treating patients who do not need hospitalization but require IV antibiotic treatment. 22,27 OPAT was reported as safe and cost-effective 24,26 and more preferable for healthcare professionals and for patients than inpatient care.…”

Section: Discussionmentioning

confidence: 99%

“…[22][23][24][25][26] OPAT for UTIs is a practical way of treating patients who do not need hospitalization but require IV antibiotic treatment. 22,27 OPAT was reported as safe and cost-effective 24,26 and more preferable for healthcare professionals and for patients than inpatient care. 28 However, the health system in Turkey does not allow the use of OPAT for the treatment of UTIs.…”

Section: Discussionmentioning

confidence: 99%

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Daily inpatient ertapenem therapy can be an alternative to hospitalization for the treatment of complicated urinary tract infections during the COVID‐19 pandemic

et al. 2021

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Background: Physicians hospitalize the patients with complicated urinary tract infections (cUTIs) when they need intravenous antibiotics and outpatient parenteral antimicrobial therapy (OPAT) is unavailable. Daily inpatient antimicrobial therapy is an alternative to hospitalization, which is similar to OPAT; patients go home after they are administered antibiotics in a separate room in the hospital setting.Objectives: We assessed our previous daily inpatient practice to revitalize the model in the COVID-19 era. Materials and Methods:We retrospectively evaluated the clinical and microbiological responses and the cost effectiveness of the patients with cUTIs who received daily inpatient ertapenem therapy. Results:Our study population was 136 patients in 156 episodes. It was a difficultto-treat group with older age (mean 63.0 ± 14.8 years) and a high burden of underlying conditions (86.5%). The most common causative organisms were Escherichia coli (74.4%) and Klebsiella pneumoniae (19.2%); 89.7% of the isolates were producing extended-spectrum beta lactamase (ESBL). The microbiologic and clinical success rates were 82.1% and 95.5%, respectively. The patients required hospitalization in 16 episodes (10.2%) because of clinical failures (3.8%), superinfections (2%), planned invasive interventions (3.2%), and side effects (1.2%). Our university hospital saved 1608 bed-days and 2596 € (9702 TL) bed costs. Conclusions:In the COVID-19 pandemic period, this seems to be an effective, safe, and cost-effective way to decrease hospitalizations for cUTIs in settings where OPAT is unavailable. What's known• Antimicrobial resistance in the complicated urinary tract infections is a global challenge for optimal antimicrobial treatment.• Hospitalization of these patients has increased the cost, risk of transmissions of COVID-19, and infections.• Ertapenem is suitable for outpatient parenteral antimicrobial therapy (OPAT).How to cite this article: Nazli Zeka A, Avkan-Oguz V, Irmak C, et al. Daily inpatient ertapenem therapy can be an alternative to hospitalization for the treatment of complicated urinary tract infections during the COVID-19 pandemic. Int J Clin Pract.

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“…OPAT was equally effective, safer and significantly less expensive than inpatient care [13]. In Mexico, outpatient ertapenem therapy was studied in an ESBL-high-prevalence area and the treatment course was found to be effective, safe and cost-saving when compared to inpatient care [14].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with successful completion of outpatient parenteral antibiotic therapy in an area with a high prevalence of multidrug-resistant bacteria: 30-day hospital admission and mortality rates

Salles

Cerrato

Santana³

et al. 2020

PLoS ONE

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Objectives To identify factors associated with hospital admission and mortality within the first 30 days after enrolment in an outpatient parenteral antimicrobial therapy (OPAT) program, also analysing adequacy of the treatment regimen and clinical outcomes. Patients and methods This was a retrospective cohort study conducted between October 2016 and June 2017 in the state of São Paulo, Brazil. Variables related to hospital admission and mortality were subjected to bivariate analysis, and those with a P<0.05 were subjected to multivariate analysis as risk factors. Results We evaluated 276 patients, of whom 80.5% were ≥60 years of age and 69.9% had more than one comorbidity. Of the patients evaluated, 41.3% had pneumonia and 35.1% had a urinary tract infection. The most common etiological agent, isolated in 18 (31.6%) cases, was Klebsiella pneumoniae, and 13 (72,2%) strains were carbapenem resistant. The OPAT was in accordance with the culture results in 76.6% of the cases and with the institutional protocols in 76.4%. The majority (64.5%) of the patients were not admitted, and a cure or clinical improvement was achieved in 78.6%. Multivariate analysis showed that, within the first 30 days after enrolment, the absence of a physician office visit was a predictor of hospital admission (P<0.001) and mortality (P = 0.006). Conclusions This study demonstrated the viability of OPAT in elderly patients with pulmonary or urinary tract infections in an area with a high prevalence of multidrug-resistant bacteria and that a post-discharge physician office visit is protective against hospital admission and mortality.

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Outpatient ertapenem therapy in an ESBL-high-prevalence area: an efficacy, safety, and cost study

Cited by 6 publications

References 21 publications

Efficacy and cost‐effectivity analysis of outpatient parenteral antimicrobial therapy unit in infectious disease clinical practices: Turkey perspective

Efficacy and cost‐effectivity analysis of outpatient parenteral antimicrobial therapy unit in infectious disease clinical practices: Turkey perspective

Daily inpatient ertapenem therapy can be an alternative to hospitalization for the treatment of complicated urinary tract infections during the COVID‐19 pandemic

Factors associated with successful completion of outpatient parenteral antibiotic therapy in an area with a high prevalence of multidrug-resistant bacteria: 30-day hospital admission and mortality rates

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