Supervised self-administration of outpatient parenteral antibiotic therapy: a report from a large tertiary hospital in Australia

Abstract

There were 150 episodes involving 144 patients resulting in 3520 days of OPAT; the median duration on the programme was 22 days (range 4–106 days). Patient or carer administration occurred in the majority of episodes. The most common indication by far was bone or joint infection (47% of patients), followed by infective endocarditis (9%). Staphylococcus aureus was the most frequently treated organism. The overall cure rate was 93%. On multivariate analysis, patients with two or more comorbidities had an increased risk of failure. Line-related complications occurred in 1.4/1000 catheter-days. Rash was the most common drug-related event. Despite the extensive use of broad-spectrum antibiotics there were no cases of Clostridium difficile infection during therapy and for up to 28 days post cessation of intravenous antibiotics. The cost of OPAT per patient excluding drug administration and home visits was approximately A$ 150.00/day, significantly lower than the cost of an inpatient bed, which is estimated to be A$ 500–800/day.5 CONCLUSION: OPAT using a patient or carer administration model is an effective and safe option for the management of selected patients with infection requiring intravenous antibiotics.

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

“…Twenty‐six studies published between 1997 and 2016 analysed the safety and effectiveness of OPAT services. This included 3 prospective studies without comparison group and 23 retrospective studies without comparison group . Nine studies were performed in Europe, eight in the USA, two in Australia, two in New Zealand, two in Singapore, one in Canada, one in Saudi Arabia and one in Israel .…”

“…Study populations varied from 56 to 4005. Treatments in these studies included those for infections in bone and joint, endovascular, soft tissue, respiratory, central nervous system and other minor infections . Details of these studies are given in Table .…”

“…Only two studies analysed factors associated with treatment failure or clinical deterioration; these studies reported that two or more comorbid conditions, patients’ age ≥70 and IV administration by health staff rather than self‐administration or outpatient IV administration were the biggest risk factors.…”

“…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 …”

“…The studies used a number of indicators to study the safety and effectiveness of HITH or OPAT: cure or success rate; treatment failure rate; mortality rate; rate of complications with vascular access devices (VAD) including thrombosis, occlusion, removal, infection, phlebitis and bleeding; adverse drug reactions; unplanned telephone calls; unscheduled staff callouts; hospital readmission; treatment extension; and adverse events as defined by the Harvard Medical Practice Study—“the adverse event is an unplanned injury or complication caused by healthcare management which leads to disability, death or prolonged hospital stay.”…”