Outpatient parenteral antibiotic therapy (OPAT) at home in Attica, Greece

Abstract

Outpatient parenteral antibiotic therapy (OPAT) is considered to be a cost-effective and safe alternative treatment strategy to hospitalization. We retrospectively evaluated data regarding the demographic and treatment characteristics of patients that sought medical advice from a network of physicians performing house-call visits and who received OPAT at home during a 17-month period (May 2009 to September 2010) in Attica, Greece. A total of 91 patients (69.2 % females) received intravenous antibiotic therapy at home during the evaluated period. The mean age [± standard deviation (SD)] of the patients was 85.3 (± 9) years. The main indications were pneumonia [46 patients (50.5 %)], urinary tract infection [25 (27.5 %)], and gastrointestinal tract infection [9 (9.9 %)]. Of the patients, 76.4 % received a beta-lactam, 17.5 % a fluoroquinolone, 15.3 % an imidazole, 8.7 % an aminoglycoside, and 5.4 % a lincosamide. The cure rate was 72.5 % and mortality was 27.5 %. The mean duration (± SD) of intravenous antibiotic treatment was 4.7 (± 3.3) days. The mean cost per patient was <euro>637 and was comparable to the mean cost if the patient were to be hospitalized for the same infection. There was significant clinical effectiveness of OPAT at home in this mainly elderly population, at an acceptable cost.

Safety and effectiveness of ‘hospital in the home’ and ‘outpatient parenteral antimicrobial therapy’ in different age groups: A systematic review of observational studies

“…Theocharis et al reported a rate of mortality of 27% and a cure rate of 72.5%, which could be due to the advanced age (85.3 ± 9 years) and comorbidities of the patients. Another study with 2 groups (above 60 years and below 60 years) performed by Cox et al reported similar rates of VAD related complications in both groups (22.4%/26.6%) and the rates of drug‐related adverse events were 22.4%/14.5%; the cure rate was 92%/94%.…”

“…In our study, more than 88% of the studies reported a cure or treatment success rate of greater than 80%. Readmission rate varied from 1% to 26%, mortality varied from 0 to 27.5% . VAD related complications ranged from 0% to 29% and adverse drug reactions rate varied from 0% to 30.2% .…”

“…Numerous studies assessing the adverse events (AEs) and effectiveness of HITH and OPAT have been performed in many countries including Australia, USA, UK, Spain, France, Singapore, Israel, Canada, Italy, Ireland, New Zealand, Saudi Arabia, Switzerland and Greece . Some studies have analysed the safety of HITH or OPAT for a particular disease or for a particular group including geriatric or paediatric patients …”

Development and implementation of a pharmacist-managed outpatient parenteral antimicrobial therapy program

“…In addition, OPAT has been shown to be safe and effective for a wide range of infectious diseases (ID), including skin and soft tissue infections (cellulitis, osteomyelitis, and septic arthritis), bacteremia, endocarditis, pyelonephritis, meningitis, brain abscess, and intraabdominal infections. [1][2][3][4][5][6][7][8][9][10][11] In 2004, the Infectious Diseases Society of America (IDSA) published guidelines outlining the safe and effective practice of OPAT, with specific recommendations addressing (1) appropriate patient evaluation and selection, (2) essential elements of an OPAT program, (3) roles and responsibilities of individual OPAT team members, (4) appropriate selection and administration of antibiotics for OPAT, and (5) laboratory monitoring parameters and recommended frequencies according to the antimicrobial agent used. 1 The IDSA guideline recommendations on appropriate patient and antibiotic selection for OPAT support current antimicrobial stewardship efforts directed at ensuring judicious and cost-effective use of antimicrobial agents.…”

“…1,5 Common models for the delivery of OPAT include the infusion center model, the selfadministration model, and the long-term care facility model. 1,4,6,9,11,12 In the infusion center model, OPAT is administered in a variety of settings (e.g., hospital clinic, emergency department, urgent care center, physician's office, freestanding infusion facility). The primary limitation of this model is the need for frequent patient transportation to receive OPAT.…”