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Gil-Navarro MV, Luque-Marquez R, Báez-Gutiérrez N, Álvarez-Marín R, Navarro-Amuedo MªD, Praena-Segovia J, Carmona-Caballero JM, Fraile-Ramos E, López-Cortés LE. Antifungal treatment administered in OPAT programs is a safe and effective option in selected patients. Enferm Infecc Microbiol Clin 2020; 38:479-484. [PMID: 32143891 DOI: 10.1016/j.eimc.2020.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Outpatient parenteral antimicrobial therapy (OPAT) has been recognised as a useful, cost-effective and safe alternative to inpatient treatment. Nevertheless, the most common antimicrobials used are antibiotics, and there is less information about the use of antifungal therapy (AT). The aim of this study is to analyse a cohort of patients treated with AT administered via OPAT and to compare them with patients from the rest of the cohort (RC) treated with antibiotics. METHODS Prospective observational study with post hoc (or retrospective) analysis of a cohort of patients treated in the OPAT program. We selected the patients treated with antifungals between July 2012 and December 2018. We recorded demographic and clinical data to analyse the validity of the treatment and to compare the differences between the AT and the RC. RESULTS Of the 1101 patients included in the OPAT program, 24 (2.18%) were treated with AT, 12 Liposomal Amphotericin B, 6 echinocandins and 6 fluconazole. This result is similar to other cohorts. There were differences between the AT vs RC in the number of patients with neoplasia (58.3% vs 28%; p=0.001), IC Charlson>2 (58.3% vs 38.8; p=0.053), duration of treatment (15 days vs 10.39 days; p=0.001) and patients with central catheters (54.2% vs 21.7%; p=0.0001). These differences are justified because there were more hematologic patients included in the AT group. Nevertheless, there were no differences in adverse reactions (25% vs 32.3%; p=0.45) or re-admissions (12.5% vs 10%; p=0.686) and OPAT with AT was successful in 21/24 patients (87.5%). CONCLUSIONS AT can be successfully administered in OPAT programs in selected patients, that are clinically stable and monitored by an infectious disease physician.
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Affiliation(s)
- Maria Victoria Gil-Navarro
- Unidad Clínica de Farmacia, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Rafael Luque-Marquez
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, Centro Superior de Investigaciones Científicas, Sevilla, Spain
| | - Nerea Báez-Gutiérrez
- Unidad Clínica de Farmacia, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio, Sevilla, Spain.
| | - Rocío Álvarez-Marín
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, Centro Superior de Investigaciones Científicas, Sevilla, Spain
| | - M ª Dolores Navarro-Amuedo
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, Centro Superior de Investigaciones Científicas, Sevilla, Spain
| | - Julia Praena-Segovia
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, Centro Superior de Investigaciones Científicas, Sevilla, Spain
| | - Juan Manuel Carmona-Caballero
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, Centro Superior de Investigaciones Científicas, Sevilla, Spain
| | - Elena Fraile-Ramos
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, Centro Superior de Investigaciones Científicas, Sevilla, Spain
| | - Luis Eduardo López-Cortés
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla/Centro Superior de Investigaciones Científicas, Sevilla, Spain
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Pajarón M, Lisa M, Fernández-Miera MF, Dueñas JC, Allende I, Arnaiz AM, Sanroma-Mendizábal P, De Berrazueta JR, Fariñas MC. Efficiency of a self-administered outpatient parenteral antimicrobial therapy (s-opat) for infective endocarditis within the context of a shortened hospital admission based on hospital at home program. Hosp Pract (1995) 2017; 45:246-252. [PMID: 29090606 DOI: 10.1080/21548331.2017.1398588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to evaluate the efficiency of treatment of infectious endocarditis (IE) via Self-administered Outpatient Parenteral Antimicrobial Therapy (S-OPAT) supported by a shortening hospital admission program in a hospitalization-at-home unit (HAH), including a short review of the literature. METHODS Ambispective cohort study of 57 episodes of IE in 54 patients treated in an HAH unit between 1988 and 2014 who receive S-OPAT after prior intra-hospital clinical stabilization. Characteristics of each episode of IE, safety and efficiency of the care model, were analyzed. RESULTS Forty-three (76%) patients were males with a median age of 61 years (SD = 16.5). A total of 37 (65%) episodes affected the native valve (42% the aortic valve). In 75%, a micro-organism was isolated, of which 88% were Gram-positive bacteria. No deaths occurred during HAH program, clinical complications appeared in 30% of episodes, only 6 patients were re-admitted to hospital although no patient died. In the 12 months' follow-up 3 cases had a recurrence. The average cost of a day stay in HAH was €174 while in traditional cardiology hospitalization was €1100. The total average cost of treatment of each episode of IE managed entirely in hospital was calculated as €54,723. Application of the S-OPAT model based on HAH meant a cost reduction of 32.72%. CONCLUSIONS In suitably selected patients, treatment of IE based on S-OPAT supported by a shortening hospital admission care program by means of referral to a HAH unit is a safe and efficient care model which entails a significant cost saving for the public healthcare system.
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Affiliation(s)
- Marcos Pajarón
- a Domiciliary Hospitalisation Unit , Hospital Universitario Marqués de Valdecilla , Santander , Spain
| | - Marta Lisa
- b Internal Medicine Unit , Hospital Universitario Marqués de Valdecilla , Santander , Spain
| | - Manuel F Fernández-Miera
- a Domiciliary Hospitalisation Unit , Hospital Universitario Marqués de Valdecilla , Santander , Spain
| | - Juan C Dueñas
- c Financial Management , Hospital Universitario Marqués de Valdecilla , Santander , Spain
| | - I Allende
- d Primary Care and Community Medicine , Santa Cruz de Bezana Health Center , Santander , Spain
| | - Ana M Arnaiz
- e Infectious Disease Unit , Hospital Universitario Marqués de Valdecilla , Santander , Spain
| | - Pedro Sanroma-Mendizábal
- a Domiciliary Hospitalisation Unit , Hospital Universitario Marqués de Valdecilla , Santander , Spain
| | - José R De Berrazueta
- f Service of Cardiology , Hospital Universitario Marqués de Valdecilla, University of Cantabria , Santander , Spain
| | - María C Fariñas
- g Infectious Disease Unit, Hospital Universitario Marqués de Valdecilla , University of Cantabria , Santander , Spain
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González-Ramallo VJ, Mirón-Rubio M, Mujal A, Estrada O, Forné C, Aragón B, Rivera AJ. Costs of outpatient parenteral antimicrobial therapy (OPAT) administered by Hospital at Home units in Spain. Int J Antimicrob Agents 2017; 50:114-118. [PMID: 28499957 DOI: 10.1016/j.ijantimicag.2017.02.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/17/2017] [Accepted: 02/22/2017] [Indexed: 10/19/2022]
Abstract
The aim of this study was to assess the direct healthcare costs of outpatient parenteral antimicrobial therapy (OPAT) administered by Hospital at Home (HaH) units in Spain. An observational, multicentre, economic evaluation of retrospective cohorts was conducted. Patients were treated at home by the HaH units of three Spanish hospitals between January 2012 and December 2013. From the cost accounting of HaH OPAT (staff, pharmacy, transportation, diagnostic tests and structural), the cost of each outpatient course was obtained following a top-down strategy based on the use of resources. Costs associated with inpatient stay, if any, were estimated based on length of stay and ICD-9-CM diagnosis. There were 1324 HaH episodes in 1190 patients (median age 70 years). The median (interquartile range) stay at home was 10 days (7-15 days). Of the OPAT episodes, 91.5% resulted in cure or improvement on completion of intravenous therapy. The mean total cost of each infectious episode was €6707 [95% confidence interval (CI) €6189-7406]. The mean cost per OPAT episode was €1356 (95% CI €1247-1560), mainly distributed between healthcare staff costs (46%) and pharmacy costs (39%). The mean cost of inpatient hospitalisation of an infectious episode was €4357 (95% CI €3947-4977). The cost per day of inpatient hospitalisation was €519, whilst the cost per day of OPAT was €98, meaning a saving of 81%. This study shows that OPAT administered by HaH units resulted in lower costs compared with inpatient care in Spain.
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Affiliation(s)
- V J González-Ramallo
- Hospital at Home Unit, Department of Internal Medicine, Gregorio Marañón Hospital, Madrid, Spain.
| | - M Mirón-Rubio
- Hospital at Home Unit, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
| | - A Mujal
- Hospital at Home Unit, Department of Internal Medicine, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | - O Estrada
- Northern Metropolitan Area, Catalan Health Institute (ICS), Badalona, Barcelona, Spain
| | - C Forné
- Department of Health Economics and Outcomes Research, Oblikue Consulting, Barcelona, Spain
| | - B Aragón
- Merck Sharp & Dohme Corp., Madrid, Spain
| | - A J Rivera
- Merck Sharp & Dohme Corp., Madrid, Spain
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Mirón-Rubio M, González-Ramallo V, Estrada-Cuxart O, Sanroma-Mendizábal P, Segado-Soriano A, Mujal-Martínez A, Del Río-Vizoso M, García-Lezcano M, Martín-Blanco N, Florit-Serra L, Gil-Bermejo M. Intravenous antimicrobial therapy in the hospital-at-home setting: data from the Spanish Outpatient Parenteral Antimicrobial Therapy Registry. Future Microbiol 2016; 11:375-90. [DOI: 10.2217/fmb.15.141] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aim: To evaluate outpatient parenteral antimicrobial therapy (OPAT) in the hospital-at-home (HaH) model, using data from a Spanish registry. Patients & methods: We describe episodes/characteristics of patients receiving OPAT. Results: Four thousand and five patients were included (mean age 66.2 years), generating 4416 HaH episodes, 4474 infections and 5088 antibiotic treatments. Most patients were from the hospital admission ward and emergency department. Respiratory, urinary and intra-abdominal infections predominated (72%). Forty-six different antimicrobials were used, including combinations of ≥2 drugs (20.7%). Most HaH episodes had a successful outcome (91%). Conclusion: Our findings are similar to those obtained previously although our study case profiles differ, suggesting that disease processes of greater severity and complexity can be treated using this healthcare model, without compromising patient safety.
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Affiliation(s)
| | | | | | | | | | - Abel Mujal-Martínez
- Hospital de Sabadell. Corporació Universitària Parc Taulí, Sabadell, Barcelona, Spain
| | | | | | | | | | - Mercè Gil-Bermejo
- Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Rodríguez Cerrillo M. [Alternatives to conventional hospitalization in a cost-containment era]. Med Clin (Barc) 2014; 143:404-7. [PMID: 25110181 DOI: 10.1016/j.medcli.2014.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 02/09/2014] [Accepted: 02/13/2014] [Indexed: 11/28/2022]
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Bascones-Martínez A, Muñoz-Corcuera M, Bascones-Ilundain J. [Relationship between odontogenic infections and infective endocarditis]. Med Clin (Barc) 2011; 138:312-7. [PMID: 21632067 DOI: 10.1016/j.medcli.2011.03.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Revised: 03/26/2011] [Accepted: 03/31/2011] [Indexed: 10/18/2022]
Abstract
Revised guidelines for the prevention of infective endocarditis published by national and international associations in the last years do not support the indiscriminate use of antibiotic prophylaxis for dental procedures. However, some of them still recommend its use in high-risk patients before dental treatments likely to cause bleeding. Given the high prevalence of bacteremia of dental origin due to tooth-brushing, mastication or other daily activities, it appears unlikely that infective endocarditis from oral microorganisms can be completely prevented. A good oral health status and satisfactory level of oral hygiene are sufficient to control the consequences of the systemic spread of oral microorganisms in healthy individuals. However, caution is still needed and prophylactic antibiotics must be administered to susceptible or medically compromised patients. This review briefly outlines the current concepts of odontogenic bacteremia and antibiotic prophylaxis for patients undergoing dental treatment.
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Affiliation(s)
- Antonio Bascones-Martínez
- Departamento de Medicina y Cirugía Bucofacial, Facultad de Odontología, Universidad Complutense de Madrid, Madrid, España.
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Daptomicina en el paciente con hospitalización a domicilio. Med Clin (Barc) 2010; 135 Suppl 3:48-54. [DOI: 10.1016/s0025-7753(10)70040-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Pardos-Gea J, Pérez-López J, San José Laporte A, Vilardell Tarrés M. Tratamiento antibiótico intravenoso domiciliario del absceso hepático: seguridad, eficacia y factores pronósticos de reingreso hospitalario. Med Clin (Barc) 2010; 134:473-6. [DOI: 10.1016/j.medcli.2009.10.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 10/05/2009] [Accepted: 10/06/2009] [Indexed: 10/19/2022]
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