Outpatient Parenteral Antibiotic Therapy in Primary Hip and Knee Arthroplasty Infection Managed with Debridement and Retention of Prosthesis: A Retrospective Cohort Study

Sims, Alex L; Baker, Paul; Bellamy, Richard; McMurtry, Ian

doi:10.1089/sur.2012.078

Cited by 7 publications

(6 citation statements)

References 20 publications

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“…In the remaining studies that considered acceptability in OPAT patients only, most involved multiple OPAT models (and did not differentiate between them in their findings), or did not specify the model(s) under study. For the most part, satisfaction with treatment was very high, 11 26 28 42 45 48 51 52 55–57 59 74 89 90 104 105 108 113 120 123 124 including where patients had to have frequent attendance at hospital. 22 135 Commonly perceived advantages of OPAT included the ability to resume daily activities, 45 56 59 74 feelings of improved self-esteem or greater freedom and control, 48 56 74 82 93 and not having to remain in or attend hospital.…”

Section: Resultsmentioning

confidence: 99%

Clinical and cost-effectiveness, safety and acceptability ofcommunityintravenousantibioticservice models: CIVAS systematic review

et al. 2017

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ObjectiveEvaluate evidence of the efficacy, safety, acceptability and cost-effectiveness of outpatient parenteral antimicrobial therapy (OPAT) models.DesignA systematic review.Data sourcesMEDLINE, EMBASE, CINAHL, Cochrane Library, National Health Service (NHS) Economic Evaluation Database (EED), Research Papers in Economics (RePEc), Tufts Cost-Effectiveness Analysis (CEA) Registry, Health Business Elite, Health Information Management Consortium (HMIC), Web of Science Proceedings, International Pharmaceutical Abstracts, British Society for Antimicrobial Chemotherapy website. Searches were undertaken from 1993 to 2015.Study selectionAll studies, except case reports, considering adult patients or practitioners involved in the delivery of OPAT were included. Studies combining outcomes for adults and children or non-intravenous (IV) and IV antibiotic groups were excluded, as were those focused on process of delivery or clinical effectiveness of 1 antibiotic over another. Titles/abstracts were screened by 1 reviewer (20% verified). 2 authors independently screened studies for inclusion.Results128 studies involving >60 000 OPAT episodes were included. 22 studies (17%) did not indicate the OPAT model used; only 29 involved a comparator (23%). There was little difference in duration of OPAT treatment compared with inpatient therapy, and overall OPAT appeared to produce superior cure/improvement rates. However, when models were considered individually, outpatient delivery appeared to be less effective, and self-administration and specialist nurse delivery more effective. Drug side effects, deaths and hospital readmissions were similar to those for inpatient treatment, but there were more line-related complications. Patient satisfaction was high, with advantages seen in being able to resume daily activities and having greater freedom and control. However, most professionals perceived challenges in providing OPAT.ConclusionsThere were no systematic differences related to the impact of OPAT on treatment duration or adverse events. However, evidence of its clinical benefit compared with traditional inpatient treatment is lacking, primarily due to the dearth of good quality comparative studies. There was high patient satisfaction with OPAT use but the few studies considering practitioner acceptability highlighted organisational and logistic barriers to its delivery.

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Section: Resultsmentioning

confidence: 99%

Clinical and cost-effectiveness, safety and acceptability ofcommunityintravenousantibioticservice models: CIVAS systematic review

et al. 2017

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“…Additionally, the information regarding to PPJI was limited. Thirteen publications mentioned treatment of bone and joint infections (Table 7[9-11,13-15,17,18,20,21,23,25-28]). Of those, only two defined the affected bones or joints in detail.…”

Section: Discussionmentioning

confidence: 99%

“…Of those, only two defined the affected bones or joints in detail. One study (Sims et al[25]) specifically looked at PPJI of the hip and knee. Therefore, it was the only study to provide economic information for this particular subset of patients.…”

Section: Discussionmentioning

confidence: 99%

Cost-analysis of inpatient and outpatient parenteral antimicrobial therapy in orthopaedics: A systematic literature review

Boese¹,

Lechler²,

Frink³

et al. 2019

WJCC

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BACKGROUND Increasing numbers of total joint arthroplasties and consecutive revision surgery are associated with the risk of periprosthetic joint infections (PPJI). Treatment of PPJI is complex and associated with immense socio-economic burden. One treatment aspect is parenteral antiinfective therapy, which usually requires an inpatient setting [Inpatient parenteral antibiotic therapy (IPAT)]. An alternative is outpatient parenteral treatment [Outpatient parenteral antibiotic therapy (OPAT)]. To conduct a health economic cost-benefit analysis of OPAT, a detailed cost analysis of IPAT and OPAT is required. So far, there is a lack of knowledge on the health economic effects of IPAT and OPAT for PPJI. AIM To review an economic comparison of IPAT and OPAT. METHODS A systematic literature review was performed through Medline following the PRISMA guidelines. RESULTS Of 619 identified studies, 174 included information of interest and 21 studies were included for quantitative analysis of OPAT and IPAT costs. Except for one study, all showed relevant cost savings for OPAT compared to IPAT. Costs for IPAT were between 1.10 to 17.34 times higher than those for OPAT. CONCLUSION There are only few reports on OPAT for PPJI. Detailed analyses to support economic or clinical guidelines are therefore limited. There is good clinical evidence supporting economic benefits of OPAT, but more high quality studies are needed for PPJI.

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“…Of note, none of our patients had SC teicoplanin infusion exceeding 600 mg, reported as an independent risk factor for local reaction in the study by El Samad et al [29]. Subcutaneous teicoplanin may be particularly useful in patients with BJI eligible for OPAT achieving efficacy and allowing cost reduction [30, 31]. Some authors have even proposed a 3-injections weekly regimen with a satisfactory success rate and an estimated saving of $60,000 per episode of BJI [32, 33].…”

Section: Discussionmentioning

confidence: 94%

Teicoplanin-based antimicrobial therapy in Staphylococcus aureus bone and joint infection: tolerance, efficacy and experience with subcutaneous administration

et al. 2016

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Background Staphylococci represent the first etiologic agents of bone and joint infection (BJI), leading glycopeptides use, especially in case of methicillin-resistance or betalactam intolerance. Teicoplanin may represent an alternative to vancomycin because of its acceptable bone penetration and possible subcutaneous administration.MethodsAdults receiving teicoplanin for S. aureus BJI were included in a retrospective cohort study investigating intravenous or subcutaneous teicoplanin safety and pharmacokinetics.ResultsSixty-five S. aureus BJIs (orthopedic device-related infections, 69 %; methicillin-resistance, 17 %) were treated by teicoplanin at the initial dose of 5.7 mg/kg/day (IQR, 4.7–6.5) after a loading dose of 5 injections 12 h apart. The first trough teicoplanin level (Cmin) reached the therapeutic target (15 mg/L) in 26 % of patients, only. An overdose (Cmin >25 mg/L) was observed in 16 % patients, 50 % of which had chronic renal failure (p = 0.049). Seven adverse events occurred in 6 patients (10 %); no predictive factor could be highlighted. After a 91-week follow-up (IQR, 51–183), 27 treatment failures were observed (42 %), associated with diabetes (OR, 5.1; p = 0.057), systemic inflammatory disease (OR, 5.6; p = 0.043), and abscess (OR, 4.1; p < 10−3). A normal CRP-value at 1 month was protective (OR, 0.2; p = 0.029). Subcutaneous administration (n = 14) showed no difference in pharmacokinetics and tolerance compared to the intravenous route.ConclusionsTeicoplanin constitutes a well-tolerated therapeutic alternative in S. aureus BJI, with a possible subcutaneous administration in outpatients. The loading dose might be increase to 9–12 mg/kg to quickly reach the therapeutic target, but tolerance of such higher doses remains to be evaluated, especially if using the subcutaneous route.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1955-7) contains supplementary material, which is available to authorized users.

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Outpatient Parenteral Antibiotic Therapy in Primary Hip and Knee Arthroplasty Infection Managed with Debridement and Retention of Prosthesis: A Retrospective Cohort Study

Abstract: Use of OHPAT for deep infection after primary arthroplasty has a high success rate. It is effective at identifying patients failing treatment, is cost-effective, and has a high level of patient satisfaction.

Cited by 7 publications

References 20 publications

Clinical and cost-effectiveness, safety and acceptability ofcommunityintravenousantibioticservice models: CIVAS systematic review

Clinical and cost-effectiveness, safety and acceptability ofcommunityintravenousantibioticservice models: CIVAS systematic review

Cost-analysis of inpatient and outpatient parenteral antimicrobial therapy in orthopaedics: A systematic literature review

Teicoplanin-based antimicrobial therapy in Staphylococcus aureus bone and joint infection: tolerance, efficacy and experience with subcutaneous administration

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