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Ferro Rodríguez S, Chantres Legaspi Y, Romay Lema EM, Ayuso García B, Castellano Copa P, Peinó Camba P, Barcia Losada A, Rodríguez Díaz C. [Translated article] Retrospective study of home antibiotic infusion therapy using elastomeric infusion pumps. FARMACIA HOSPITALARIA 2024; 48:T153-T158. [PMID: 38679534 DOI: 10.1016/j.farma.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 12/17/2023] [Accepted: 12/26/2023] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVES To describe the experience of home antibiotic infusion therapy using elastomeric infusion pumps, administered to patients admitted to the Home Hospitalisation Unit of a tertiary hospital for 3 years and to analyse clinical evolution and mortality. METHOD Retrospective observational study. The medical history of the patients included in the study was reviewed. Information was obtained on personal history, antimicrobial therapy received, and clinical evolution. Statistical analysis was performed using SPSS® 19 software. RESULTS 81 patients were included, 61.7% men, with a mean age of 73.5±17.5 years. The most frequent comorbidities were diabetes mellitus (30.9%) and chronic kidney disease (28.4%). Patients received a mean of 11.9±8.5 days of antibiotic treatment in an elastomeric infusion pump. The main focus of infection was respiratory (27.2%), followed by bacteremia (16%) and skin and soft tissue infections (12.3%). Of the infections, 65.4% were monomicrobial, with Pseudomonas aeruginosa being the main microorganism involved (39.6%). The most commonly used antimicrobial was piperacillin/tazobactam (33.3%). The clinical course was good in 85.2% of the patients, but the mortality rate in the 30 days following the end of treatment was 24.7%. In the univariate analysis, a history of neoplasia in the last 5 years (p=.01) and having received fewer days of antibiotic therapy prior to the start of outpatient antimicrobial therapy in infusion pump (p=.04) were associated with worse clinical outcome. Age over 80 years was associated with better outcome (p=.03). The diagnosis of heart failure was associated with higher mortality (p=.026) and patients from surgical services, with lower mortality (p=.047). In the multivariate analysis, the presence of neoplasia was associated with unfavourable evolution (p=.012) and heart failure with higher mortality (p=.027). CONCLUSIONS Outpatient antimicrobial therapy in elastomeric infusion pumps is an alternative in patients requiring prolonged intravenous treatment, and age is not a conditioning factor for inclusion in these programs. However, the presence of certain comorbidities can negatively affect the clinical course and mortality of patients.
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Affiliation(s)
| | | | - Eva María Romay Lema
- Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario de Lugo, Lugo, Spain
| | - Blanca Ayuso García
- Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario de Lugo, Lugo, Spain
| | | | - Pedro Peinó Camba
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de Lugo, Lugo, Spain
| | - Andrea Barcia Losada
- Servicio de Hospitalización a Domicilio, Complejo Hospitalario Universitario de Lugo, Lugo, Spain
| | - Cristina Rodríguez Díaz
- Servicio de Hospitalización a Domicilio, Complejo Hospitalario Universitario de Lugo, Lugo, Spain
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Ferro Rodríguez S, Chantres Legaspi Y, Romay Lema EM, Ayuso García B, Castellano Copa P, Peinó Camba P, Barcia Losada A, Rodríguez Díaz C. Retrospective study of home antibiotic infusion therapy in elastomeric infusion pumps. FARMACIA HOSPITALARIA 2024; 48:153-158. [PMID: 38336554 DOI: 10.1016/j.farma.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 12/17/2023] [Accepted: 12/26/2023] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVES To describe the experience of home antibiotic infusion therapy using elastomeric infusion pumps, administered to patients admitted to the Home Hospitalization Unit of a tertiary hospital for three years and to analyse clinical evolution and mortality. METHOD Retrospective observational study. The medical history of the patients included in the study was reviewed. Information was obtained on personal history, antimicrobial therapy received and clinical evolution. Statistical analysis was performed using SPSS® 19 software. RESULTS Eighty-one patients were included, 61.7% men, with a mean age of 73.5 ± 17.5 years. The most frequent comorbidities were diabetes mellitus (30.9%) and chronic kidney disease (28.4%). Patients received a mean of 11.9 ± 8.5 days of antibiotic treatment in an elastomeric infusion pump. The main focus of infection was respiratory (27.2%), followed by bacteremia (16%) and skin and soft tissue infections (12.3%). Of the infections, 65.4% were monomicrobial, with Pseudomonas aeruginosa being the main microorganism involved (39.6%). The most commonly used antimicrobial was piperacillin/tazobactam (33.3%). The clinical course was good in 85.2% of the patients, but the mortality rate in the 30 days following the end of treatment was 24.7%. In the univariate analysis, a history of neoplasia in the last 5 years (p = 0.01) and having received fewer days of antibiotic therapy prior to the start of outpatient antimicrobial therapy in infusion pump (p = 0.04) were associated with worse clinical outcome. Age over 80 years was associated with better outcome (p = 0.03). The diagnosis of heart failure was associated with higher mortality (p = 0.026) and patients from surgical services, with lower mortality (p = 0.047). In the multivariate analysis, the presence of neoplasia was associated with unfavorable evolution (p = 0.012) and heart failure with higher mortality (p = 0.027). CONCLUSIONS Outpatient antimicrobial therapy in elastomeric infusion pumps is an alternative in patients requiring prolonged intravenous treatment, and age is not a conditioning factor for inclusion in these programs. However, the presence of certain comorbidities can negatively affect the clinical course and mortality of patients.
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Affiliation(s)
- Sara Ferro Rodríguez
- Servicio de Farmacia, Complejo Hospitalario Universitario de Lugo, Lugo, España.
| | | | - Eva María Romay Lema
- Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario de Lugo, Lugo, España
| | - Blanca Ayuso García
- Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario de Lugo, Lugo, España
| | | | - Pedro Peinó Camba
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de Lugo, Lugo, España
| | - Andrea Barcia Losada
- Servicio de Hospitalización a Domicilio, Complejo Hospitalario Universitario de Lugo, Lugo, España
| | - Cristina Rodríguez Díaz
- Servicio de Hospitalización a Domicilio, Complejo Hospitalario Universitario de Lugo, Lugo, España
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Faller E, Jackson A. A cost minimisation analysis comparing oral linezolid and intravenous daptomycin administered via an outpatient parenteral antibiotic therapy programme in patients requiring prolonged antibiotic courses. J Chemother 2023; 35:411-424. [PMID: 36398996 DOI: 10.1080/1120009x.2022.2145452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 11/20/2022]
Abstract
This study is an economic analysis seeking to examine cost savings that may be accrued from usage of oral linezolid in place of OPAT IV daptomycin in patients requiring prolonged courses of IV or highly bioavailable oral antibiotic therapy. In order to do so we conducted a literature review to establish the scenarios in which the agents could be considered equivalent. We then, using a decision-tree model, conducted a cost analysis to establish differences in cost between the approaches. Under the model base-case, the total cost of treatment with OPAT daptomycin was €3,496.84 and the total cost of treatment with oral linezolid was €772.01. Therefore the oral linezolid strategy would be projected to save the Irish health service €2,724.83 per patient. These results were robust to one-way deterministic sensitivity analyses and probabilistic sensitivity analysis. Our study suggests that significant savings could be safely accrued in the management of these patients.
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Affiliation(s)
- E Faller
- Infectious Disease Department, Cork University Hospital (CUH), Cork, Ireland
- London School of Economics and Political Science, London, UK
| | - A Jackson
- Infectious Disease Department, Cork University Hospital (CUH), Cork, Ireland
- School of Medicine, UCC, College Road, Cork, Ireland
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Rodríguez-Martínez L, Castro-Balado A, Hermelo-Vidal G, Bandín-Vilar E, Varela-Rey I, Toja-Camba FJ, Rodríguez-Jato T, Novo-Veleiro I, Varela-García PM, Zarra-Ferro I, González-Barcia M, Mondelo-García C, Mateos J, Fernández-Ferreiro A. Ampicillin Stability in a Portable Elastomeric Infusion Pump: A Step Forward in Outpatient Parenteral Antimicrobial Therapy. Pharmaceutics 2023; 15:2099. [PMID: 37631313 PMCID: PMC10458095 DOI: 10.3390/pharmaceutics15082099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) with continuous infusion pumps is postulated as a very promising solution to treat complicated infections, such as endocarditis or osteomyelitis, that require patients to stay in hospital during extended periods of time, thus reducing their quality of life and increasing the risk of complications. However, stability studies of drugs in elastomeric devices are scarce, which limits their use in OPAT. Therefore, we evaluated the stability of ampicillin in sodium chloride 0.9% at two different concentrations, 50 and 15 mg/mL, in an elastomeric infusion pump when stored in the refrigerator and subsequently in real-life conditions at two different temperatures, 25 and 32 °C, with and without the use of a cooling device. The 15 mg/mL ampicillin is stable for up to 72 h under refrigeration, allowing subsequent dosing at 25 °C for 24 h with and without a cooling device, but at 32 °C its concentration drops below 90% after 8 h. In contrast, 50 mg/mL ampicillin only remains stable for the first 24 h under refrigeration, and subsequent administration at room temperature is not possible, even with the use of a cooling system. Our data support that 15 mg/mL AMP is suitable for use in OPAT if the volume and rate of infusion are tailored to the dosage needs of antimicrobial treatments.
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Affiliation(s)
- Lorena Rodríguez-Martínez
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (L.R.-M.); (A.C.-B.); (A.F.-F.)
| | - Ana Castro-Balado
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (L.R.-M.); (A.C.-B.); (A.F.-F.)
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
- Pharmacology, Pharmacy and Pharmaceutical Technology Department, Faculty of Pharmacy, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain
| | - Gonzalo Hermelo-Vidal
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (L.R.-M.); (A.C.-B.); (A.F.-F.)
| | - Enrique Bandín-Vilar
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (L.R.-M.); (A.C.-B.); (A.F.-F.)
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
- Pharmacology, Pharmacy and Pharmaceutical Technology Department, Faculty of Pharmacy, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain
| | - Iria Varela-Rey
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (L.R.-M.); (A.C.-B.); (A.F.-F.)
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
- Pharmacology, Pharmacy and Pharmaceutical Technology Department, Faculty of Pharmacy, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain
| | - Francisco José Toja-Camba
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (L.R.-M.); (A.C.-B.); (A.F.-F.)
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
- Pharmacology, Pharmacy and Pharmaceutical Technology Department, Faculty of Pharmacy, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain
| | - Teresa Rodríguez-Jato
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (L.R.-M.); (A.C.-B.); (A.F.-F.)
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Ignacio Novo-Veleiro
- Home Hospitalization Unit, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Pablo Manuel Varela-García
- Internal Medicine Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Irene Zarra-Ferro
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (L.R.-M.); (A.C.-B.); (A.F.-F.)
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Miguel González-Barcia
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (L.R.-M.); (A.C.-B.); (A.F.-F.)
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Cristina Mondelo-García
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (L.R.-M.); (A.C.-B.); (A.F.-F.)
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Jesús Mateos
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (L.R.-M.); (A.C.-B.); (A.F.-F.)
| | - Anxo Fernández-Ferreiro
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (L.R.-M.); (A.C.-B.); (A.F.-F.)
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
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Kutubi A, O'Brien L, Murphy B, Fitzpatrick P, Hurson C, Rajendran D, Feeney E, Mallon P, Waqas S. A single centre experience of prosthetic joint infection outcomes with outpatient parenteral antimicrobial therapy. Heliyon 2023; 9:e15212. [PMID: 37113779 PMCID: PMC10126847 DOI: 10.1016/j.heliyon.2023.e15212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 03/26/2023] [Accepted: 03/29/2023] [Indexed: 04/29/2023] Open
Abstract
Objectives Prosthetic joint infection (PJI) is a serious complication following arthroplasties. This study assessed the clinical outcomes, readmission rates and financial impact of PJIs treated with outpatient parenteral antimicrobial therapy (OPAT). Methods The study used prospectively collected data from the OPAT patient database at a tertiary care Irish hospital for PJI cases managed between 2015 and 2020. Data was analyzed using IBM-SPSS. Results Forty-one patients with PJIs were managed via OPAT over five years, with median age of 71.6 years. Median duration of OPAT was 32 days. Hospital readmission occurred in 34% of cases. Reasons for readmission included progression of infection in 64.3%, unplanned reoperation in 21.4% and planned admission for joint revision in 14.3%. Type 2 Diabetes Mellitus (T2DM) was found to have a statistically significant association with unplanned readmission (OR 8.5, CI 95% 1.1-67.6; p < 0.01). OPAT saved a mean of 27.49 hospital-bed days per patient. 1,127 bed days were saved in total, estimating a total savings of 963,585 euros and median savings of 26,505 euros. Conclusions The readmission rate observed was comparable to international data. Most readmissions were related to primary infections rather than due to OPAT-specific complications. Our main findings were that patients with PJIs can be safely managed via OPAT, and the finding of association between T2DM and increased risk of readmission.
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Affiliation(s)
| | - Luke O'Brien
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Ben Murphy
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Patricia Fitzpatrick
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
- University College Dublin, Belfield, Dublin 4, Ireland
| | - Conor Hurson
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Deepa Rajendran
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Eoin Feeney
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
- University College Dublin, Belfield, Dublin 4, Ireland
| | - Patrick Mallon
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
- University College Dublin, Belfield, Dublin 4, Ireland
| | - Sarmad Waqas
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
- University College Dublin, Belfield, Dublin 4, Ireland
- Tallaght University Hospital, Dublin 24, Ireland
- Trinity College Dublin, Dublin 2, Ireland
- Corresponding author.
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Fernández-Polo A, Ramon-Cortes S, Plaja-Dorca J, Bartolomé-Comas R, Vidal-Valdivia L, Soler-Palacín P. Impact of an outpatient parenteral antimicrobial treatment (OPAT) as part of a paediatric-specific PROA program. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 41:230-234. [PMID: 35961853 DOI: 10.1016/j.eimce.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/07/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Outpatient parenteral antimicrobial treatment (OPAT) is an alternative to in-patient care in carefully selected patients. This study presents a self-administration OPAT program integrated within the pediatric antibiotic stewardship program (ASP) in a pediatric tertiary care center. MATERIAL AND METHODS Descriptive, retrospective and unicentric study. Data from all patients under 20 years of age who were prescribed treatment by a pediatric unit during 2019 and 2020 were included. Data regarding number of saved beds and estimating the opportunity cost of the OPAT program for the hospital were analyzed. RESULTS Fifty-seven patients received 106 episodes of treatment. Favorable clinical outcome occurred in 74.5% of the episodes. The main cause of premature interruption was unfavorable clinical outcome of the infection (37.1%). A total of 2.62 beds/day were saved, resulting in an economic benefit of 1,069,963 €. CONCLUSION A self-administration OPAT program integrated within the pediatric ASP has proven to be safe and effective and provides economic benefits.
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Affiliation(s)
- Aurora Fernández-Polo
- Servicio de Farmacia, Hospital Infantil, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain.
| | | | | | - Rosa Bartolomé-Comas
- Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Servicio de Microbiología, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain
| | - Lis Vidal-Valdivia
- Unidad de Hepatología y Trasplante Hepático Pediátrico, Hospital Infantil, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain
| | - Pere Soler-Palacín
- Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Unidad de Patología Infecciosa e Inmunodeficiencias de Pediatría, Hospital Infantil, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain
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Esteban-Cartelle B, Vicente-Oliveros N, Menéndez-Conde CP, Serrano DR, Martín-Dávila P, Fortún-Abete J, León-Gil LA, Álvarez-Díaz A. Antibiotic stability in portable elastomeric infusion devices: A systematic review. Am J Health Syst Pharm 2022; 79:1355-1368. [PMID: 35511829 DOI: 10.1093/ajhp/zxac122] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE Although outpatient parenteral antibiotic therapy (OPAT) can be a good approach to treatment of infections, a lack of data regarding antibiotic stability in portable elastomeric infusion devices restricts its safe, appropriate, and effective use. The objective of this work was to complete a systematic peer-reviewed analysis of published articles about antibiotic stability in elastomeric infusion devices that provide evidence supporting their use in OPAT. SUMMARY A systematic review following PRISMA guidelines was conducted in January 2021 to identify published articles about antibiotic stability in portable elastomeric infusion devices. The databases used were PubMed, Embase, Web of Science, and a Cochrane database. A total of 1,615 original studies and conference communications were found. After title, abstract, and full-text review, 33 articles met the inclusion criteria. The data obtained included information about the stability of 30 different antibiotics. To our knowledge, this is the first review to summarize the available published data on the stability of antibiotics in portable elastomeric infusion devices. The results highlight the poor stability of some antibiotics in solution and the variability of the laboratory conditions in the included studies. CONCLUSION This systematic review can serve as a useful resource for healthcare professionals involved in providing OPAT using portable elastomeric infusion devices. However, further stability studies should be performed, especially high-quality studies simulating real-life time and temperature conditions.
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Affiliation(s)
- Beatriz Esteban-Cartelle
- Ramón y Cajal University Hospital, Madrid, Spain, and Department of Pharmaceutics and Food Technology, School of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | | | | | - Dolores R Serrano
- Department of Pharmaceutics and Food Technology, School of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | - Pilar Martín-Dávila
- Service of Infectious Diseases, Ramón y Cajal University Hospital, Madrid, Spain
| | - Jesús Fortún-Abete
- Service of Infectious Diseases, Ramón y Cajal University Hospital, Madrid, Spain
| | | | - Ana Álvarez-Díaz
- Pharmacy Department, Ramón y Cajal University Hospital, Madrid, Spain
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Fernández-Polo A, Ramon-Cortes S, Plaja-Dorca J, Bartolomé-Comas R, Vidal-Valdivia L, Soler-Palacín P. Impacto del tratamiento antimicrobiano domiciliario endovenoso (TADE) como parte de un programa de optimización del uso de antimicrobianos (PROA) específico para pediatría. Enferm Infecc Microbiol Clin 2021. [DOI: 10.1016/j.eimc.2021.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Underwood J, Marks M, Collins S, Logan S, Pollara G. Intravenous catheter-related adverse events exceed drug-related adverse events in outpatient parenteral antimicrobial therapy. J Antimicrob Chemother 2020; 74:787-790. [PMID: 30462237 PMCID: PMC6376853 DOI: 10.1093/jac/dky474] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 10/09/2018] [Accepted: 10/16/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Drug-related adverse events (AEs) are reported to be common amongst patients receiving outpatient parenteral antimicrobial therapy (OPAT). However, comparative data regarding intravenous (iv) catheter-related AEs are lacking. OBJECTIVES To compare drug- and iv catheter-related AEs from a large UK OPAT centre. PATIENTS AND METHODS We reviewed 544 OPAT episodes [median (IQR) age: 57 (39-71) years, 60% male, 13% with diabetes] with a median (IQR) duration of 7 (2-18) days. Clinically significant drug- and iv catheter-related AEs were calculated as a percentage of OPAT episodes with an AE and also as AEs per 1000 iv drug/catheter days. RESULTS Drug-related AEs complicated 13 (2.4%) OPAT episodes at 1.7 (95% CI 0.9-2.9) per 1000 drug days. Catheter-related AEs occurred more frequently, complicating 32 (5.9%) episodes at 5.7 (95% CI 4.2-7.9) per 1000 iv catheter days (χ2 test for difference in AE rate: P < 0.001). Non-radiologically guided midline catheters were associated with the most frequent AEs (n = 23) at 15.6 (95% CI 10.3-23.4) per 1000 iv catheter days compared with other types of iv catheters (HR 8.4, 95% CI 2.4-51.9, P < 0.004), and self-administration was associated with a higher rate of catheter-related AEs at 12.0 (95% CI 6.0-23.9) per 1000 iv catheter days (HR 4.15, 95% CI 1.7-9.1, P = 0.007). CONCLUSIONS Clinically significant iv catheter-related AEs occurred more frequently than drug-related AEs, especially when using non-radiologically guided midline catheters. Regular review of the need for iv therapy and switching to oral antimicrobials when appropriate is likely to minimize OPAT-related AEs.
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Affiliation(s)
- Jonathan Underwood
- The Hospital for Tropical Diseases, Division of Infection, University College London Hospitals NHS Foundation Trust, London, UK
| | - Michael Marks
- The Hospital for Tropical Diseases, Division of Infection, University College London Hospitals NHS Foundation Trust, London, UK.,Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Steve Collins
- The Hospital for Tropical Diseases, Division of Infection, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sarah Logan
- The Hospital for Tropical Diseases, Division of Infection, University College London Hospitals NHS Foundation Trust, London, UK
| | - Gabriele Pollara
- The Hospital for Tropical Diseases, Division of Infection, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Infection & Immunity, University College London, London, UK
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Restelli U, Bonfanti M, Croce D, Grau S, Metallidis S, Moreno Guillén S, Pacelli V, Rizzardini G, Soro M, Vozikis A, Gray A. Organisational and financial consequences of the early discharge of patients treated for acute bacterial skin and skin structure infection and osteomyelitis in infectious disease departments in Greece, Italy and Spain: a scenario analysis. BMJ Open 2019; 9:e031356. [PMID: 31515433 PMCID: PMC6747647 DOI: 10.1136/bmjopen-2019-031356] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The aim of the analysis is to assess the organisational and economic consequences of adopting an early discharge strategy for the treatment of acute bacterial skin and skin structure infection (ABSSSI) and osteomyelitis within infectious disease departments. SETTING Infectious disease departments in Greece, Italy and Spain. PARTICIPANTS No patients were involved in the analysis performed. INTERVENTIONS An analytic framework was developed to consider two alternative scenarios: standard hospitalisation care or an early discharge strategy for patients hospitalised due to ABSSSI and osteomyelitis, from the perspective of the National Health Services of Greece, Italy and Spain. The variables considered were: the number of annual hospitalisations eligible for early discharge, the antibiotic treatments considered (ie, oral antibiotics and intravenous long-acting antibiotics), diagnosis-related group (DRG) reimbursements, number of days of hospitalisation, incidence and costs of hospital-acquired infections, additional follow-up visits and intravenous administrations. Data were based on published literature and expert opinions. PRIMARY AND SECONDARY OUTCOME MEASURES Number of days of hospitalisation avoided and direct medical costs avoided. RESULTS The total number of days of hospitalisation avoided on a yearly basis would be between 2216 and 5595 in Greece (-8/-21 hospital beds), between 15 848 and 38 444 in Italy (-57/-135 hospital beds) and between 7529 and 23 520 in Spain (-27/-85 hospital beds). From an economic perspective, the impact of the early discharge scenario is a reduction between €45 036 and €149 552 in Greece, a reduction between €182 132 and €437 990 in Italy and a reduction between €292 284 and €884 035 in Spain. CONCLUSIONS The early discharge strategy presented would have a positive organisational impact on National Health Services, leading to potential savings in beds, and to a reduction of hospital-acquired infections and costs.
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Affiliation(s)
- Umberto Restelli
- Center for Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marzia Bonfanti
- Center for Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
| | - Davide Croce
- Center for Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
| | - Santiago Grau
- Pharmacy Department, Hospital del Mar, Barcelona, Spain
| | - Symeon Metallidis
- Medical School of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Santiago Moreno Guillén
- Department of Infectious Diseases, Hospital Ramón y Cajal, University of Alcalá, Madrid, Spain
| | - Valeria Pacelli
- Center for Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
| | - Giuliano Rizzardini
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marco Soro
- Global HEOR, Angelini, Roma, Lazio, Italy
| | - Athanasios Vozikis
- Laboratory of Health Economics and Management, University of Piraeus, Piraeus, Greece
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Psaltikidis EM, Silva END, Moretti ML, Trabasso P, Stucchi RSB, Aoki FH, Cardoso LGDO, Höfling CC, Bachur LF, Ponchet DDF, Colombrini MRC, Tozzi CS, Ramos RF, Costa SMQ, Resende MR. Cost-utility analysis of outpatient parenteral antimicrobial therapy (OPAT) in the Brazilian national health system. Expert Rev Pharmacoecon Outcomes Res 2018; 19:341-352. [PMID: 30362845 DOI: 10.1080/14737167.2019.1541404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Outpatient parenteral antimicrobial therapy (OPAT) has been used for decades in different countries to reduce hospitalization rates, with favorable clinical and economic outcomes. This study assesses the cost-utility of OPAT compared to inpatient parenteral antimicrobial therapy (IPAT) from the perspective of a public university hospital and the Brazilian National Health System (Unified Health System -SUS). METHODS Prospective study with adult patients undergoing OPAT at an infusion center, compared to IPAT. Clinical outcomes and quality-adjusted life year (QALY) were assessed, as well as a micro-costing. Cost-utility analysis from the hospital and SUS perspectives were conducted by means of a decision tree, within a 30-day horizon time. RESULTS Forty cases of OPAT (1112 days) were included and monitored, with a favorable outcome in 97.50%. OPAT compared to IPAT generated overall savings of 31.86% from the hospital perspective and 26.53% from the SUS perspective. The intervention reduced costs, with an incremental cost-utility ratio of -44,395.68/QALY for the hospital and -48,466.70/QALY for the SUS, with better cost-utility for treatment times greater than 14 days. Sensitivity analysis confirmed the stability of the model. CONCLUSION Our economic assessment demonstrated that, in the Brazilian context, OPAT is a cost-saving strategy both for hospitals and for the SUS.
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Affiliation(s)
- Eliane Molina Psaltikidis
- a Hospital Epidemiology Department and Health Technology Assessment Department , Clinical Hospital of State University of Campinas , Campinas , Brazil.,b School of Medical Sciences , State University of Campinas , Campinas , Brazil
| | | | - Maria Luiza Moretti
- d Division of Infectious Diseases, Internal Medicine Department, School of Medical Sciences , State University of Campinas , Campinas , Brazil.,e Hospital Epidemiology Department , Clinical Hospital of State University of Campinas , Campinas , Brazil
| | - Plínio Trabasso
- d Division of Infectious Diseases, Internal Medicine Department, School of Medical Sciences , State University of Campinas , Campinas , Brazil.,e Hospital Epidemiology Department , Clinical Hospital of State University of Campinas , Campinas , Brazil
| | - Raquel Silveira Bello Stucchi
- d Division of Infectious Diseases, Internal Medicine Department, School of Medical Sciences , State University of Campinas , Campinas , Brazil.,f Day-Hospital , Clinical Hospital of State University of Campinas , Campinas , Brazil
| | - Francisco Hideo Aoki
- d Division of Infectious Diseases, Internal Medicine Department, School of Medical Sciences , State University of Campinas , Campinas , Brazil
| | | | - Christian Cruz Höfling
- e Hospital Epidemiology Department , Clinical Hospital of State University of Campinas , Campinas , Brazil
| | - Luis Felipe Bachur
- e Hospital Epidemiology Department , Clinical Hospital of State University of Campinas , Campinas , Brazil
| | | | | | - Cíntia Soarez Tozzi
- f Day-Hospital , Clinical Hospital of State University of Campinas , Campinas , Brazil
| | - Rosana Fins Ramos
- f Day-Hospital , Clinical Hospital of State University of Campinas , Campinas , Brazil
| | | | - Mariângela Ribeiro Resende
- a Hospital Epidemiology Department and Health Technology Assessment Department , Clinical Hospital of State University of Campinas , Campinas , Brazil.,d Division of Infectious Diseases, Internal Medicine Department, School of Medical Sciences , State University of Campinas , Campinas , Brazil
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12
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A retrospective analysis of adverse events among patients receiving daptomycin versus vancomycin during outpatient parenteral antimicrobial therapy. Infect Control Hosp Epidemiol 2018; 39:947-954. [PMID: 29893658 DOI: 10.1017/ice.2018.107] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Outpatient parenteral antimicrobial therapy (OPAT) is a safe and effective alternative to prolonged inpatient stays for patients requiring long-term intravenous antimicrobials, but antimicrobial-associated adverse events remain a significant challenge. Thus, we sought to measure the association between choice of antimicrobial agent (vancomycin vs daptomycin) and incidence of adverse drug events (ADEs). METHODS Patients receiving OPAT treatment with vancomycin or daptomycin for skin and soft-tissue infections, bone and joint infections, endocarditis, and bacteremia or endovascular infections during the period from July 1, 2013, through September 30, 2016, were included. Demographic and clinical data were abstracted from the medical record. Logistic regression was used to compare ADEs requiring a change in or early discontinuation of therapy, hospital readmission, and emergency room visits between groups. Time from OPAT enrollment to ADE was compared using the log-rank test. RESULTS In total, 417 patients were included: 312 (74·8%) received vancomycin and 105 (25·2%) received daptomycin. After adjusting for age, Charlson comorbidity index, location of OPAT treatment, receipt of combination therapy with either β-lactam or fluoroquinolone, renal function, and availability of safety labs, patients receiving vancomycin had significantly higher incidence of ADEs (adjusted odds ratio [aOR], 3·71; 95% CI, 1·64-8·40). ADEs occurred later in the treatment course for patients treated with daptomycin (P<·01). Rates of readmission and emergency room visits were similar. CONCLUSIONS In the OPAT setting, vancomycin use was associated with higher incidence of ADEs than daptomycin use. This finding is an important policy consideration for programs aiming to optimize outcomes and minimize cost. Careful selection of gram-positive agents for prolonged treatment is necessary to limit toxicity.
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