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Chesdachai S, Rivera CG, Rosedahl JK, Philpot LM, Dholakia R, Borah BJ, Draper EW, Arndt R, Ganesh R, Larsen JJ, Destro Borgen MJ, Razonable RR. Outpatient remdesivir treatment program for hospitalized patients with coronavirus disease-2019: Patient perceptions, process and economic impact. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2024; 12:100750. [PMID: 39142233 DOI: 10.1016/j.hjdsi.2024.100750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 06/28/2024] [Accepted: 08/08/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Remdesivir is FDA-approved for the treatment of hospitalized patients with severe COVID-19. Many patients improve clinically to allow for hospital dismissal before completing the 5-day course. In a prior work, patients who continued remdesivir in an outpatient setting experienced better 28-day clinical outcomes. Here, we assessed patients' perspectives and the economic impact of this outpatient practice. METHODS Hospitalized patients who received remdesivir for COVID-19 at Mayo Clinic, Rochester, from 11/6/2020 to 11/5/2021 and were dismissed to continue remdesivir in the outpatient setting were surveyed. The cost of care was compared between those who remained hospitalized versus those who were dismissed. RESULTS 93 (19.8 %) among 470 eligible patients responded to the electronic survey. Responders were older than non-responders. The majority (70.5 %) had symptoms resolved by the time of the survey. Ten (11.4 %) patients had persistent symptoms attributed to long COVID-19. The majority were satisfied with the quality of care (82.3 %) and overall experience (76.0 %) in the infusion clinic. After adjusting for gender, comorbidity score, and WHO severity scale, the predicted costs for the groups were $16,544 (inpatient) and $9,097 (outpatient) per patient (difference of $7,447; p < .01). An estimate of 1,077 hospital bed-days were made available to other patients as a result of this transition to outpatient. CONCLUSION An outpatient remdesivir program that allowed for early dismissal was perceived favorably by patients. The program resulted in significant cost and resource savings, the latter in terms of the availability of hospital beds for other patients needing critical services.
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Affiliation(s)
- Supavit Chesdachai
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA.
| | | | - Jordan K Rosedahl
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Lindsey M Philpot
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA; Department of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ruchita Dholakia
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Bijan J Borah
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Evan W Draper
- Department of Pharmacy, Mayo Clinic, Rochester, MN, USA
| | - Richard Arndt
- Department of Pharmacy, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Ravindra Ganesh
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Molly J Destro Borgen
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
| | - Raymund R Razonable
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA.
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Mohammed SA, Roberts JA, Cotta MO, Rogers B, Pollard J, Assefa GM, Erku D, Sime FB. Safety and efficacy of outpatient parenteral antimicrobial therapy: A systematic review and meta-analysis of randomized clinical trials. Int J Antimicrob Agents 2024; 64:107263. [PMID: 38960209 DOI: 10.1016/j.ijantimicag.2024.107263] [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: 04/16/2024] [Revised: 06/05/2024] [Accepted: 06/25/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Outpatient parenteral antimicrobial therapy (OPAT) offers an alternative to inpatient (hospital bed-based) treatment of infections that require intravenous administration of antimicrobials. This meta-analysis aimed to summarise the evidence available from randomised controlled trials (RCTs) regarding the efficacy and safety of OPAT compared to inpatient parenteral antimicrobial therapy. METHODS We searched the Cochrane Library, MEDLINE, Embase, PubMed, and Web of Sciences databases for RCTs comparing outpatient versus inpatient parenteral antimicrobial therapy. We included studies without restrictions on language or publication year. Eligibility was reviewed independently by two assessors, and data extraction was cross validated. We evaluated bias risk via the Cochrane tool and determined the evidence certainty using GRADE. Meta-analysis was conducted using a random effects model. The protocol of this review was registered on PROSPERO (CRD42023460389). RESULT Thirteen RCTs, involving 1,310 participants were included. We found no difference in mortality (Risk Ratio [RR] 0.54, 95% Confidence Interval [CI] 0.23 to 1.26; P = 0.93), treatment failure (RR 1.0, CI 0.59 to 1.72; P = 0.99), adverse reaction related to antimicrobials (RR 0.89, CI 0.69 to 1.15; P = 0.38), and administration device (RR 0.58, CI 0.17 to 1.98; P = 0.87) between outpatient and inpatient parenteral antimicrobial therapy. The overall body of evidence had a low level of certainty. CONCLUSION Existing evidence suggests OPAT is a safe and effective alternative to inpatient treatment. Further RCTs are warranted for a thorough comparison of inpatient and outpatient parenteral antimicrobial therapy with a high level of certainty.
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Affiliation(s)
- Solomon Ahmed Mohammed
- UQ Centre for Clinical Research, The University of Queensland, Queensland, Australia; Department of Pharmacy, Wollo University, Dessie, Ethiopia
| | - Jason A Roberts
- UQ Centre for Clinical Research, The University of Queensland, Queensland, Australia; Department of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Queensland, Australia; Herston Infectious Disease Institute (HeIDI), Metro North Health, Queensland, Australia; Division of Anaesthesiology Critical Care Emerging and Pain Medicine, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Menino Osbert Cotta
- UQ Centre for Clinical Research, The University of Queensland, Queensland, Australia; Herston Infectious Disease Institute (HeIDI), Metro North Health, Queensland, Australia
| | - Benjamin Rogers
- Centre for Inflammatory Disease, Monash University, Melbourne, Australia
| | - James Pollard
- Cabrini @ Home, Cabrini Health, Melbourne, Australia
| | - Getnet Mengistu Assefa
- UQ Centre for Clinical Research, The University of Queensland, Queensland, Australia; Department of Pharmacy, Wollo University, Dessie, Ethiopia
| | - Daniel Erku
- Centre for Applied Health Economics, Griffith University, Queensland, Australia
| | - Fekade B Sime
- UQ Centre for Clinical Research, The University of Queensland, Queensland, Australia.
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Schmidt-Hellerau K, Baade N, Günther M, Scholten N, Lindemann CH, Leisse C, Oberröhrmann C, Peter S, Jung N, Suarez I, Horn C, Ihle P, Küpper-Nybelen J, Hagemeier A, Hellmich M, Lehmann C. Outpatient parenteral antimicrobial therapy (OPAT) in Germany: insights and clinical outcomes from the K-APAT cohort study. Infection 2024; 52:1407-1414. [PMID: 38478255 PMCID: PMC11289149 DOI: 10.1007/s15010-024-02199-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/25/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE Outpatient parenteral antimicrobial therapy (OPAT) offers several key advantages, including enhanced patient quality of life, reduced healthcare costs, and a potential reduction of nosocomial infections. It is acknowledged for its safety and effectiveness. This study provides the first systematic clinical data for Germany, where OPAT has not yet been widely adopted. The aim is to establish a foundational reference point for further research and integration of OPAT into the German healthcare system. METHODS This prospective observational study descriptively analyses data obtained from a cohort of patients receiving OPAT. Both in- and outpatients from all medical specialties could be recruited. Patients administered the anti-infective medications themselves at home using elastomeric pumps. RESULTS 77 patients received OPAT, with a median duration of 15 days and saving 1782 inpatient days. The most frequently treated entities were orthopaedic infections (n = 20, 26%), S. aureus bloodstream infection (n = 16, 21%) and infectious endocarditis (n = 11, 14%). The most frequently applied drugs were flucloxacillin (n = 18, 23%), penicillin G (n = 13, 17%) and ceftriaxone (n = 10; 13%). Only 5% of patients (n = 4) reported to have missed more than one outpatient dose (max. 3 per patient). Only one catheter-related adverse event required medical intervention, and there were no catheter-related infections. CONCLUSION The study demonstrates that OPAT can be safely conducted in Germany. In preparation for its broader implementation, crucial next steps include creating medical guidelines, fostering interdisciplinary and inter-sectoral communication, as well as creating financial and structural regulations that facilitate and encourage the adoption of OPAT. TRIAL REGISTRATION NUMBER NCT04002453.
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Affiliation(s)
- Kirsten Schmidt-Hellerau
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Nina Baade
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Marina Günther
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Nadine Scholten
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christoph Heinrich Lindemann
- Department II of Internal Medicine and Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Charlotte Leisse
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Charlotte Oberröhrmann
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Sophie Peter
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Chair of General Practice II and Patient-Centeredness in Primary Care, Institute of General Practice and Primary Care, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Norma Jung
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Isabelle Suarez
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Carola Horn
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Peter Ihle
- PMV Forschungsgruppe, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Jutta Küpper-Nybelen
- PMV Forschungsgruppe, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Anna Hagemeier
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Clara Lehmann
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.
- German Center for Infection Research (DZIF), Bonn-Cologne, Germany.
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Wolie ZT, Roberts JA, Gilchrist M, McCarthy K, Sime FB. Current practices and challenges of outpatient parenteral antimicrobial therapy: a narrative review. J Antimicrob Chemother 2024:dkae177. [PMID: 38842523 DOI: 10.1093/jac/dkae177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Extended hospitalization for infection management increases inpatient care costs and the risk of healthcare-associated adverse events, including infections. The growing global demand for healthcare, the diminishing availability of hospital beds and an increasing patient preference for care within their own home have been the primary drivers of the expansion of hospital-in-the-home programmes. Such programmes include the use of IV antimicrobials in outpatient settings, known as outpatient parenteral antimicrobial therapy (OPAT). However, OPAT practices vary globally. This review article aims to describe the current OPAT practices and challenges worldwide. OPAT practice begins with patient evaluation and selection using eligibility criteria, which requires collaboration between the interdisciplinary OPAT team, patients and caregivers. Depending on care requirements, eligible patients may be enrolled to various models of care, receiving medication by healthcare professionals at outpatient infusion centres, hospital clinics, home visits or through self-administration. OPAT can be used for the management of many infections where an effective oral treatment option is lacking. Various classes of parenteral antimicrobials, including β-lactams, aminoglycosides, glycopeptides, fluoroquinolones and antifungals such as echinocandins, are used globally in OPAT practice. Despite its benefits, OPAT has numerous challenges, including complications from medication administration devices, antimicrobial side effects, monitoring requirements, antimicrobial instability, patient non-adherence, patient OPAT rejection, and challenges related to OPAT team structure and administration, all of which impact its outcome. A negative outcome could include unplanned hospital readmission. Future research should focus on mitigating these challenges to enable optimization of the OPAT service and thereby maximize the documented benefits for the healthcare system, patients and healthcare providers.
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Affiliation(s)
- Zenaw T Wolie
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, QLD 4029, Australia
| | - Jason A Roberts
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, QLD 4029, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Queensland, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, 30029 Nîmes, France
| | - Mark Gilchrist
- Department of Pharmacy/Infection, Imperial College Healthcare NHS Trust, London, UK
- Department of Infectious Diseases, Imperial College, London, UK
| | - Kate McCarthy
- Royal Brisbane Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Fekade B Sime
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, QLD 4029, Australia
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Mohammed SA, Cotta MO, Assefa GM, Erku D, Sime F. Barriers and facilitators for the implementation and expansion of outpatient parenteral antimicrobial therapy: a systematic review. J Hosp Infect 2024; 147:1-16. [PMID: 38423135 DOI: 10.1016/j.jhin.2024.02.006] [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: 12/01/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) has been expanding in recent years and serves as a viable solution in reducing the shortage of hospital beds. However, the wider implementation of OPAT faces numerous challenges. This review aimed to assess implementation barriers and facilitators of OPAT services. Studies describing barriers and facilitators of the OPAT service were retrieved from PubMed, Scopus, MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Science Proceedings, International Pharmaceutical Abstracts and PsycINFO. All types of study designs published in the English language were included. Studies that did not mention any barrier or facilitator, did not differentiate OPAT and inpatient, focused on specific antimicrobials or diseases, and made no distinction between parenteral and other treatments were excluded. Qualitative analysis was performed using the 'best-fit' framework approach and the Consolidated Framework for Implementation Research (CFIR). The review was PROSPERO registered (CRD42023441083). A total of 8761 studies were screened for eligibility and 147 studies were included. Problems in patient selection, lack of awareness, poor communication and co-ordination, lack of support, lack of structured service and inappropriate prescriptions were identified. OPAT provides safe, effective and efficient treatment while maintaining patients' privacy and comfort, resulting in less daily life disruption, and reducing the risk of infection. Satisfaction and preference for OPAT were very high. Initiatives in strengthening OPAT such as antimicrobial stewardship and telemedicine are beneficial. Challenges to and facilitators of OPAT were identified among patients, health professionals, OPAT service providers and healthcare administrators. Understanding them is crucial to designing targeted initiatives for successful OPAT service implementation.
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Affiliation(s)
- S A Mohammed
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia; Department of Pharmacy, Wollo University, Dessie, Ethiopia
| | - M O Cotta
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Australia
| | - G M Assefa
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia; Department of Pharmacy, Wollo University, Dessie, Ethiopia
| | - D Erku
- Centre for Applied Health Economics, Griffith University, Nathan, Australia
| | - F Sime
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia.
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Eckmann C, Sunderkötter C, Becker K, Grabein B, Hagel S, Hanses F, Wichmann D, Thalhammer F. Left ventricular assist device-associated driveline infections as a specific form of complicated skin and soft tissue infection/acute bacterial skin and skin structure infection - issues and therapeutic options. Curr Opin Infect Dis 2024; 37:95-104. [PMID: 38085707 PMCID: PMC10911258 DOI: 10.1097/qco.0000000000000999] [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] [Indexed: 01/16/2024]
Abstract
PURPOSE OF REVIEW This review comments on the current guidelines for the treatment of wound infections under definition of acute bacterial skin and skin structure infections (ABSSSI). However, wound infections around a catheter, such as driveline infections of a left ventricular assist device (LVAD) are not specifically listed under this definition in any of the existing guidelines. RECENT FINDINGS Definitions and classification of LVAD infections may vary across countries, and the existing guidelines and recommendations may not be equally interpreted among physicians, making it unclear if these infections can be considered as ABSSSI. Consequently, the use of certain antibiotics that are approved for ABSSSI may be considered as 'off-label' for LVAD infections, leading to rejection of reimbursement applications in some countries, affecting treatment strategies, and hence, patients' outcomes. However, we believe driveline exit site infections related to LVAD can be included within the ABSSSI definition. SUMMARY We argue that driveline infections meet the criteria for ABSSSI which would enlarge the 'on-label' antibiotic armamentarium for treating these severe infections, thereby improving the patients' quality of life.
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Affiliation(s)
- Christian Eckmann
- Academic Hospital of Goettingen University, Department of General, Visceral and Thoracic Surgery, Klinikum Hannoversch-Muenden, Hannoversch-Muenden
| | - Cord Sunderkötter
- Martin-Luther-University Halle-Wittenberg, University and University Hospital of Halle, Department of Dermatology and Venerology, Halle
| | - Karsten Becker
- University Medicine Greifswald, Friedrich Loeffler-Institute of Medical Microbiology, Greifswald
| | - Béatrice Grabein
- LMU Hospital, Clinical Microbiology and Hospital Hygiene, Munich
| | - Stefan Hagel
- Jena University Hospital-Friedrich Schiller University Jena, Institute for Infectious Diseases and Infection Control, Jena
| | - Frank Hanses
- University Hospital Regensburg, Department of Infection Prevention and Infectious Diseases
- University Hospital Regensburg, Emergency Department, Regensburg
| | - Dominic Wichmann
- University Medical Center Hamburg-Eppendorf, Department of Intensive Care Medicine, Hamburg
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Durojaiye OC, Cole J, Kritsotakis EI. Effectiveness and safety of a disposable elastomeric continuous infusion pump for outpatient parenteral antimicrobial therapy (OPAT) in a UK setting. J Chemother 2024; 36:119-126. [PMID: 37942621 DOI: 10.1080/1120009x.2023.2277507] [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: 06/09/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023]
Abstract
We evaluated the effectiveness and safety of continuous antimicrobial infusion using a disposable elastomeric device in an outpatient parenteral antimicrobial therapy (OPAT) setting. We conducted a retrospective analysis of all patients who received either flucloxacillin (n = 131 episodes) or piperacillin/tazobactam (n = 301 episodes) as continuous infusion via elastomeric devices over 5 years (January 2018-December 2022) at a tertiary referral hospital in Derbyshire, UK. Overall, 81 adverse events were recorded in 77 (18%; 77/432) patient-episodes. Most adverse events were vascular access-related (59%; 4.6 events per 1000 OPAT-days), including one line-related infection (0.2%; 0.1 events per 1000 OPAT-days). 165 (38%) patient-episodes experienced at least one incident of incomplete infusion. Successful outcome (cure or improvement) occurred in 364 (84%) episodes. Our findings suggest that elastomeric infusion pumps are safe and effective for administering selected antimicrobial agents in OPAT. However, close monitoring of patients and the device are essential to ensure optimal delivery of prescribed therapy.
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Affiliation(s)
- Oyewole Christopher Durojaiye
- Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Microbiology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Joby Cole
- Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, UK
| | - Evangelos I Kritsotakis
- School of Health and Related Research, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
- Laboratory of Biostatistics, School of Medicine, University of Crete, Heraklion, Greece
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8
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Durojaiye OC, Kritsotakis EI. Evaluation of health-related quality of life in patients receiving outpatient parenteral antimicrobial therapy (OPAT) in a UK setting. Expert Rev Anti Infect Ther 2024:1-9. [PMID: 38511820 DOI: 10.1080/14787210.2024.2334059] [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: 01/16/2024] [Accepted: 02/20/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Studies assessing the benefits of outpatient parenteral antimicrobial therapy (OPAT) have paid less attention to patient-centered factors such as patients' experiences and their health-related quality of life (HRQoL). RESEARCH DESIGN AND METHODS Prospective before-and-after quasi-experimental study enrolled adult patients receiving OPAT at a tertiary hospital in Derbyshire, UK, between October 2022 and October 2023. Consenting patients completed paired EQ-5D-3 L questionnaires before OPAT initiation and upon completion of therapy or 30 days after its commencement (whichever occurred first). Changes and predictors of change in HRQoL indicators and associations with clinical outcomes (treatment failure, adverse events, and 30-day unplanned readmission) were examined. RESULTS Health state index and visual analogue scale (EQ VAS) scores of 162 enrolled patients at baseline were significantly lower than the UK population averages, but the patients experienced significant improvements in both scores and in four EQ-5D dimensions (mobility, self-care, usual activities, and pain/discomfort). Baseline health index and EQ VAS scores were significant independent predictors of positive changes in HRQoL scores. CONCLUSIONS OPAT is associated with improved patient-reported quality of life and facilitates early return to work or school. Nevertheless, it is crucial to closely monitor patients with a lower baseline quality of life to optimize their overall OPAT experience.
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Affiliation(s)
- Oyewole Christopher Durojaiye
- Department of Microbiology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, Derbyshire, UK
- Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
| | - Evangelos I Kritsotakis
- School of Medicine and Population Health, University of Sheffield, Sheffield, South Yorkshire, UK
- Laboratory of Biostatistics, School of Medicine, University of Crete, Heraklion, Greece
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Papaetis GS, Doukanaris PT, Stylianou ES, Neofytou MS. Successful Outpatient Treatment of Severe Diabetic-Foot Myositis and Osteomyelitis Caused by Extensively Drug-Resistant Enterococcus faecalis with Teicoplanin plus Rifampicin: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e941337. [PMID: 37910441 PMCID: PMC10626598 DOI: 10.12659/ajcr.941337] [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: 06/02/2023] [Revised: 09/20/2023] [Accepted: 09/05/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Foot ulcers are high-morbidity and debilitating complications of diabetes mellitus, and carry significantly increased rates of associated major amputations. They contribute to significantly worse quality of life. Osteomyelitis is a frequent complication of diabetic foot ulcers, since bacteria can contiguously spread from soft tissues to the bone, involving the cortex first and then the bone marrow. Unfortunately, clinically unsuspected osteomyelitis is frequent in persisting diabetic foot ulcers. It is associated with limb amputations and increased mortality. CASE REPORT We describe a 76-year-old man with long-standing insulin-treated type 2 diabetes, who experienced extensively drug-resistant Enterococcus faecalis diabetic foot myositis and osteomyelitis associated with sepsis. He was successfully treated with surgical debridement combined with the administration of teicoplanin plus rifampicin in the outpatient setting, completing, in total, a twelve-week course of antibiotic therapy. CONCLUSIONS Clinically unsuspected osteomyelitis in patients with persisting diabetic foot ulcers has been associated with infections from highly resistant bacteria. Early and accurate diagnosis of diabetic foot osteomyelitis, as well as proper therapeutic approach (antimicrobial and surgical), is of great importance to reduce the risk of minor and major amputations, septic shock leading to multiple organ failure, and overall mortality.
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Affiliation(s)
- Georgios S. Papaetis
- Internal Medicine and Diabetes Clinic, K.M.P. THERAPIS Paphos Medical Center, Paphos, Cyprus
- CDA College, Paphos, Cyprus
| | | | - Eleni S. Stylianou
- Department of Radiology, Alpha Evresis Diagnostic Center, Bioiatriki Healthcare Group, Nicosia, Cyprus
| | - Michalis S. Neofytou
- Department of Interventional Cardiology, American Medical Center, Nicosia, Cyprus
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10
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Manca A, Palermiti A, Mula J, Cusato J, Maiese D, Simiele M, De Nicolò A, D’Avolio A. Stability Study of Fosfomycin in Elastomeric Pumps at 4 °C and 34 °C: Technical Bases for a Continuous Infusion Use for Outpatient Parenteral Antibiotic Therapy. Pharmaceutics 2023; 15:2347. [PMID: 37765315 PMCID: PMC10537177 DOI: 10.3390/pharmaceutics15092347] [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: 08/09/2023] [Revised: 09/01/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Fosfomycin acts against aerobic Gram-/+ bacteria by blocking the synthesis of peptidoglycan. Its use has been currently re-evaluated for intravenous administration for the treatment of systemic infections by multidrug-resistant bacteria. Concentration-/time-dependent activity has been suggested, with potential clinical advantages from prolonged or continuous infusion. Nevertheless, little is known about Fosfomycin stability in elastomeric pumps. The aim of the present work was stability investigation before administration at 4 °C and during administration at 34 °C. METHODS InfectoFos® (InfectoPharm s.r.l., Milan, Italy) preparation for intravenous use in elastomeric pumps at 4 °C and 34 °C was analyzed following EMA guidelines for drug stability. Samples were analyzed with an ultra-high performance liquid chromatography coupled with tandem mass spectrometry method on a LX50® UHPLC system equipped with a QSight 220® (Perkin Elmer, Milan, Italy) tandem mass spectrometer. RESULTS Fosfomycin in elastomeric preparation is stable for at least 5 days at a storage temperature of 4 °C and 34 °C. CONCLUSIONS The results suggest Fosfomycin eligibility for continuous infusion even in the context of outpatient parenteral antibiotic therapy. Therefore, this approach should be tested in clinical and pharmacokinetic studies, in order to evaluate the possible gains in the pharmacokinetic profile and the clinical effectiveness.
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Affiliation(s)
- Alessandra Manca
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Corso Svizzera 164, 10149 Turin, Italy; (A.M.); (A.P.); (J.C.); (D.M.); (A.D.N.); (A.D.)
| | - Alice Palermiti
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Corso Svizzera 164, 10149 Turin, Italy; (A.M.); (A.P.); (J.C.); (D.M.); (A.D.N.); (A.D.)
| | - Jacopo Mula
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Corso Svizzera 164, 10149 Turin, Italy; (A.M.); (A.P.); (J.C.); (D.M.); (A.D.N.); (A.D.)
- CoQua Lab s.r.l., Corso Svizzera 185 bis, 10149 Turin, Italy;
| | - Jessica Cusato
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Corso Svizzera 164, 10149 Turin, Italy; (A.M.); (A.P.); (J.C.); (D.M.); (A.D.N.); (A.D.)
| | - Domenico Maiese
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Corso Svizzera 164, 10149 Turin, Italy; (A.M.); (A.P.); (J.C.); (D.M.); (A.D.N.); (A.D.)
| | - Marco Simiele
- CoQua Lab s.r.l., Corso Svizzera 185 bis, 10149 Turin, Italy;
| | - Amedeo De Nicolò
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Corso Svizzera 164, 10149 Turin, Italy; (A.M.); (A.P.); (J.C.); (D.M.); (A.D.N.); (A.D.)
| | - Antonio D’Avolio
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Corso Svizzera 164, 10149 Turin, Italy; (A.M.); (A.P.); (J.C.); (D.M.); (A.D.N.); (A.D.)
- CoQua Lab s.r.l., Corso Svizzera 185 bis, 10149 Turin, Italy;
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11
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Durojaiye OC, Cole J, Kritsotakis EI. Risk of venous thromboembolism in outpatient parenteral antimicrobial therapy (OPAT): A systematic review and meta-analysis. Int J Antimicrob Agents 2023; 62:106911. [PMID: 37422098 DOI: 10.1016/j.ijantimicag.2023.106911] [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: 04/05/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023]
Abstract
The risk of venous thromboembolism (VTE) in outpatient parenteral antimicrobial therapy (OPAT) is not fully understood and the optimal strategy for thromboprophylaxis remains unclear. This systematic review investigated the incidence of VTE in OPAT settings (PROSPERO CRD42022381523). MEDLINE, CINAHL, Emcare, Embase, Cochrane Library and grey literature were searched from earliest records to 18 January 2023. Primary studies reporting non-catheter-related VTE or catheter-related thromboembolism (CRT) events in adults who received parenteral antibiotics in home or outpatient settings were eligible. In total, 43 studies involving 23 432 patient episodes were reviewed, of which 4 studies reported non-catheter-related VTE and 39 included CRT. Based on generalised linear mixed-effects models, pooled risk estimates of non-catheter-related VTE and CRT were 0.2% [95% confidence interval (CI) 0.0-0.7%] and 1.1% [95% CI 0.8-1.5%; prediction interval (PI) 0.2-5.4%]. Heterogeneity was largely attributed to risk of bias by meta-regression (R2 = 21%). Excluding high-risk-of-bias studies, CRT risk was 0.8% (95% CI 0.5-1.2%; PI 0.1-4.5%). From 25 studies, the pooled CRT rate per 1000 catheter-days was 0.37 (95% CI 0.25-0.55; PI 0.08-1.64). These findings do not support universal thromboprophylaxis or routine use of an inpatient VTE risk assessment model in the OPAT setting. However, a high index of suspicion should be maintained, especially for patients with known risk factors for VTE. An optimised protocol of OPAT-specific VTE risk assessment should be sought.
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Affiliation(s)
- Oyewole Christopher Durojaiye
- Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; Department of Microbiology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, DE22 3NE, UK.
| | - Joby Cole
- Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, S10 2RX, UK
| | - Evangelos I Kritsotakis
- Laboratory of Biostatistics, School of Medicine, University of Crete, Heraklion, 71003, Greece; School of Health and Related Research, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, S1 4DA, UK
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12
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Spencer-Jones J, Luxton T, Bond SE, Sandoe J. Feasibility, Effectiveness and Safety of Elastomeric Pumps for Delivery of Antibiotics to Adult Hospital Inpatients-A Systematic Review. Antibiotics (Basel) 2023; 12:1351. [PMID: 37760648 PMCID: PMC10525832 DOI: 10.3390/antibiotics12091351] [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: 07/13/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
Elastomeric infusion pumps (EMPs) have been implemented in many fields, including analgesia, chemotherapy and cardiology. Their application in antimicrobials is mainly limited to the outpatient setting, but with a need to optimise inpatient antimicrobial treatment, the use of EMPs presents a potential option. This review aimed to identify if the use of EMPs within an inpatient setting is feasible, effective and safe for antimicrobial use. Criteria for inclusion were human studies that involved the treatment of an infection with intravenous antimicrobial agents via an EMP. A search strategy was developed covering both the indexed and grey literature, with all study designs included. The review found 1 eligible study enrolling 6 patients. There was strong patient preference for EMPs (6/6), and daily tasks were easily completed whilst attached to the EMP. Nurses (5/5) also preffered the pumps, and the majority reported them as easy to use. The review has identified the need for further research in the area. Evidence for the use of EMPs to administer antibiotics in the inpatient setting is scarce, and more work is needed to understand the advantages to patients, to healthcare workers and from an antimicrobial stewardship perspective. Potential disadvantages that may put patients at risk also need investigating.
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Affiliation(s)
| | - Timothy Luxton
- School of Biomedical Sciences, University of Leeds, Leeds LS2 9JT, UK;
| | | | - Jonathan Sandoe
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK;
- Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK
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13
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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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14
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Staples JA, Ho M, Ferris D, Liu G, Brubacher JR, Khan M, Daly-Grafstein D, Tran KC, Sutherland JM. Physician Financial Incentives for Use of Outpatient Intravenous Antimicrobial Therapy: An Interrupted Time Series Analysis. Clin Infect Dis 2023; 76:2098-2105. [PMID: 36795054 DOI: 10.1093/cid/ciad082] [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: 11/23/2022] [Revised: 01/15/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND In 2011, policymakers in British Columbia introduced a fee-for-service payment to incentivize infectious diseases physicians to supervise outpatient parenteral antimicrobial therapy (OPAT). Whether this policy increased use of OPAT remains uncertain. METHODS We conducted a retrospective cohort study using population-based administrative data over a 14-year period (2004-2018). We focused on infections that required intravenous antimicrobials for ≥10 days (eg, osteomyelitis, joint infection, endocarditis) and used the monthly proportion of index hospitalizations with a length of stay shorter than the guideline-recommended "usual duration of intravenous antimicrobials" (LOS < UDIVA) as a surrogate for population-level OPAT use. We used interrupted time series analysis to determine whether policy introduction increased the proportion of hospitalizations with LOS < UDIVA. RESULTS We identified 18 513 eligible hospitalizations. In the pre-policy period, 82.3% of hospitalizations exhibited LOS < UDIVA. Introduction of the incentive was not associated with a change in the proportion of hospitalizations with LOS < UDIVA, suggesting that the policy intervention did not increase OPAT use (step change, -0.06%; 95% confidence interval [CI], -2.69% to 2.58%; P = .97 and slope change, -0.001% per month; 95% CI, -.056% to .055%; P = .98). CONCLUSIONS The introduction of a financial incentive for physicians did not appear to increase OPAT use. Policymakers should consider modifying the incentive design or addressing organizational barriers to expanded OPAT use.
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Affiliation(s)
- John A Staples
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology & Evaluation, Vancouver, Canada
| | - Meghan Ho
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Dwight Ferris
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Guiping Liu
- Center for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Mayesha Khan
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Daniel Daly-Grafstein
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Department of Statistics, University of British Columbia, Vancouver, Canada
| | - Karen C Tran
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation & Outcome Sciences, Vancouver, Canada
| | - Jason M Sutherland
- Center for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation & Outcome Sciences, Vancouver, Canada
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15
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Ruiz F, Nunn A, Gill A, Clapham D, Fotaki N, Salunke S, Cram A, O'Brien F. A review of paediatric injectable drug delivery to inform the study of product acceptability - an introduction. Eur J Pharm Biopharm 2023:S0939-6411(23)00090-5. [PMID: 37100092 DOI: 10.1016/j.ejpb.2023.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/23/2023] [Accepted: 04/14/2023] [Indexed: 04/28/2023]
Abstract
AIM The EMA defines acceptability as "the overall ability and willingness of the patient to use, and their caregiver to administer, the medicine as intended" [1]. This paper seeks to outline issues of acceptability in relation to injectable therapy, namely intravenous (IV), intramuscular (IM) and subcutaneous (SC) administration routes, and to lay a foundation to identify a minimum set of data that would satisfy Regulatory Authorities when discussing the acceptability of an injectable product. In addition, it will alert drug product developers to other factors that might contribute to good practice, alternative administration strategies and overall adherence to achieve successful treatment. Whilst the term 'parenteral' means "outside the intestine" [2,3] and so potentially covers a range of administration routes including intranasal and percutaneous administration, this review focuses on IV, IM and SC administration by injection. The use of indwelling canulae or catheters to reduce venepuncture and facilitate prolonged treatment is common and may impact acceptability [4]. This may be influenced by information provided by the manufacturer but is not always in their direct control. Other injectable products suitable for routes such as intradermal, intra-articular, intraosseous and intrathecal, share the requirement to be acceptable but are not specifically covered in this paper [2,5].
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Affiliation(s)
- Fabrice Ruiz
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France
| | - Anthony Nunn
- University of Liverpool, Department of Women's and Children's Health, Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool, L8 7SS UK
| | - Andrea Gill
- Paediatric Medicines Research Unit, Alder Hey Children's NHSFT, Liverpool, L12 2AP UK
| | | | - Nikoletta Fotaki
- Department of Life Sciences, Centre for Therapeutic Innovation (CTI), University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Smita Salunke
- European Paediatric Formulation Initiative (EUPFI) School of Pharmacy, University College London, London WC1N 1AX, UK
| | - Anne Cram
- Pfizer R&D UK Ltd, Ramsgate Road, Sandwich CT13 9ND, UK
| | - Fiona O'Brien
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin 2, Ireland
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16
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Roberts JA, Croom K, Adomakoh N. Continuous infusion of beta-lactam antibiotics: narrative review of systematic reviews, and implications for outpatient parenteral antibiotic therapy. Expert Rev Anti Infect Ther 2023; 21:375-385. [PMID: 36867528 DOI: 10.1080/14787210.2023.2184347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
INTRODUCTION Continuous infusion (CI) of beta-lactam antibiotics may be of benefit in some patients, particularly those with severe infections. However, most studies have been small and conflicting results have been reported. The best available evidence on clinical outcomes of beta-lactam CI comes from systematic reviews/meta-analyses that integrate the available data. AREAS COVERED A search of PubMed from inception to the end of February 2022 for systematic reviews of clinical outcomes with beta-lactam CI for any indication identified 12 reviews, all of which focused on hospitalized patients, most of whom were critically ill. A narrative overview of these systematic reviews/meta-analyses is provided. No systematic reviews evaluating the use of beta-lactam CI for outpatient parenteral antibiotic therapy (OPAT) were identified, as few studies have focused on this area. Relevant data are summarized, and consideration is given to issues that need to be addressed when using beta-lactam CI in the setting of OPAT. EXPERT OPINION Evidence from systematic reviews supports a role for beta-lactam CI in the treatment of hospitalized patients with severe/life-threatening infections. Beta-lactam CI can play a role in patients receiving OPAT for severe chronic/difficult-to-treat infections, but additional data are needed to clarify its optimal use.
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Affiliation(s)
- Jason A Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia.,Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
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17
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Impact of a Dedicated Outpatient Parenteral Antimicrobial Therapy Program on Peripherally Inserted Central Catheter Removal at a Large Academic Medical Center. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2023. [DOI: 10.1097/ipc.0000000000001174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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18
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Fernández-Rubio B, Herrera-Hidalgo L, Luque-Márquez R, de Alarcón A, López-Cortés LE, Luque-Pardos S, Gutiérrez-Urbón JM, Fernández-Polo A, Gil-Navarro MV, Gutiérrez-Valencia A. Stability of Ampicillin plus Ceftriaxone Combined in Elastomeric Infusion Devices for Outpatient Parenteral Antimicrobial Therapy. Antibiotics (Basel) 2023; 12:antibiotics12030432. [PMID: 36978299 PMCID: PMC10044682 DOI: 10.3390/antibiotics12030432] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 02/24/2023] Open
Abstract
Currently, ampicillin plus ceftriaxone (AC) is one of the preferred treatments for Enterococcus faecalis infective endocarditis. However, there is a lack of stability data for the combination of both drugs in elastomeric devices, so the inclusion of AC in Outpatient Parenteral Antimicrobial Therapy (OPAT) programs is challenging. The objective of the study was to determine the stability of AC in elastomeric pumps when stored at 8 ± 2 °C, 25 ± 2 °C, 30 ± 2 °C and 37 ± 2 °C using LC-MS/MS. The combination was diluted in 0.9% sodium chloride and the final concentrations were ampicillin 24 g/L plus ceftriaxone 8 g/L. Physical and chemical stability were evaluated at 12, 20, 24, 36 and 48 h after preparation. Stability was met at each time point if the percentage of intact drug was ≥90% of its respective baseline concentration and color and clearness remained unchanged. The drug combination was stable for 48 h when it was kept at 8 ± 2 °C. At 25 ± 2 °C and 30 ± 2 °C, they were stable for 24 h of storage. At 37 ± 2 °C, the stability criterion was not met at any time point. These results prove that AC could be included in OPAT programs using elastomeric infusion devices for the treatment of E. faecalis infections.
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Affiliation(s)
- Beatriz Fernández-Rubio
- Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain
| | - Laura Herrera-Hidalgo
- Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain
- Unidad de Gestión Clinica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain
- Correspondence:
| | - Rafael Luque-Márquez
- Unidad de Gestión Clinica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain
| | - Arístides de Alarcón
- Unidad de Gestión Clinica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain
| | - Luis E. López-Cortés
- Infectious Diseases and Microbiology Clinical Unit, University Hospital Virgen Macarena, Departament of Medicine, School of Medicine, University of Sevilla, Biomedicine Institute of Sevilla (IBiS)/CSIC, 41009 Seville, Spain
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Sonia Luque-Pardos
- Unidad de Gestión Clínica de Farmacia, Hospital del Mar, 08003 Barcelona, Spain
| | - José María Gutiérrez-Urbón
- Unidad de Gestión Clínica de Farmacia, Complexo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain
| | - Aurora Fernández-Polo
- Unidad de Gestión Clínica de Farmacia, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain
| | - María V. Gil-Navarro
- Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain
- Unidad de Gestión Clinica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Alicia Gutiérrez-Valencia
- Unidad de Gestión Clinica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain
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19
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Sharp R, Xu Q, Corsini N, Turner L, Altschwager J, Marker J, Ullman A, Esterman A. Community-based Intravenous Treatment and Central Venous Access Devices: A Scoping Review of the Consumer and Caregiver Experience, Information Preferences, and Supportive Care Needs. J Community Health Nurs 2023; 40:28-51. [PMID: 36602775 DOI: 10.1080/07370016.2022.2081506] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE Map existing research and describe the consumer/caregiver experience of community-based intravenous treatment, central venous access devices (CVADs), supportive care needs, and information preferences. DESIGN Scoping review. METHODS Five databases (Joanna Briggs Institute, Cochrane library, Emcare, Embase, and Medline) were searched. Screening and data extraction were performed independently by two reviewers. FINDINGS Forty-eight studies were included. CONCLUSIONS Although community-based intravenous treatment and CVADs have a significant impact on consumers and caregivers, there is scant research on their supportive care needs and information preferences. CLINICAL EVIDENCE Some consumers and caregivers may require additional support while undergoing community-based intravenous treatment.
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Affiliation(s)
- Rebecca Sharp
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia.,Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia
| | - Qunyan Xu
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Nadia Corsini
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia
| | - Lisa Turner
- Clinical Operations, Silver Chain Group, Australia
| | | | - Julie Marker
- Cancer Voices South Australia, Adelaide, Australia
| | - Amanda Ullman
- Children's Health Queensland and Health Service/ School of Nursing, Midwifery and Social Work, The University of Queensland, Australia
| | - Adrian Esterman
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia.,Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia
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Staples JA, Ho M, Ferris D, Hayek J, Liu G, Tran KC, Sutherland JM. Outpatient Versus Inpatient Intravenous Antimicrobial Therapy: A Population-Based Observational Cohort Study of Adverse Events and Costs. Clin Infect Dis 2022; 75:1921-1929. [PMID: 35439822 DOI: 10.1093/cid/ciac298] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Bacterial infections such as osteomyelitis and endocarditis routinely require several weeks of treatment with intravenous (IV) antimicrobials. Outpatient parenteral antimicrobial therapy (OPAT) programs allow patients to receive IV antimicrobials in an outpatient clinic or at home. The outcomes and costs of such treatments remain uncertain. METHODS We conducted a retrospective observational cohort study over a 5-year study interval (1 June 2012 to 31 March 2018) using population-based linked administrative data from British Columbia, Canada. Patients receiving OPAT following a hospitalization for bacterial infection were matched based on infection type and implied duration of IV antimicrobials to patients receiving inpatient parenteral antimicrobial therapy (IPAT). Cumulative adverse events and direct healthcare costs were estimated over a 90-day outcome interval. RESULTS In a matched cohort of 1842 patients, adverse events occurred in 35.6% of OPAT patients and 39.0% of IPAT patients (adjusted odds ratio, 1.04 [95% confidence interval {CI}, .83-1.30; P = .61). Relative to IPAT patients, OPAT patients were significantly more likely to experience hospital readmission (30.5% vs 23.0%) but significantly less likely to experience Clostridioides difficile diarrhea (1.2% vs 3.1%) or death (2.0% vs 8.8%). Estimated mean direct healthcare costs were $30 166 for OPAT patients and $50 038 for IPAT patients (cost ratio, 0.60; average cost savings with OPAT, $17 579 [95% CI, $14 131-$21 027]; P < .001). CONCLUSIONS Outpatient IV antimicrobial therapy is associated with a similar overall prevalence of adverse events and with substantial cost savings relative to patients remaining in hospital to complete IV antimicrobials. These findings should inform efforts to expand OPAT use.
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Affiliation(s)
- John A Staples
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Clinical Epidemiology & Evaluation, Vancouver, Canada.,Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation & Outcome Sciences, Vancouver, Canada
| | - Meghan Ho
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Dwight Ferris
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Jan Hayek
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Guiping Liu
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Karen C Tran
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation & Outcome Sciences, Vancouver, Canada
| | - Jason M Sutherland
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation & Outcome Sciences, Vancouver, Canada
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21
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Stoorvogel HH, Hulscher MEJL, Wertheim HFL, Yzerman EPF, Scholing M, Schouten JA, ten Oever J. Current Practices and Opportunities for Outpatient Parenteral Antimicrobial Therapy in Hospitals: A National Cross-Sectional Survey. Antibiotics (Basel) 2022; 11:antibiotics11101343. [PMID: 36290001 PMCID: PMC9598700 DOI: 10.3390/antibiotics11101343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
This nationwide study assessed how outpatient parenteral antimicrobial therapy (OPAT) is organised by Dutch acute care hospitals, the barriers experienced, and how an OPAT program affects the way hospitals organised OPAT care. We systematically developed and administered a survey to all 71 Dutch acute care hospitals between November 2021 and February 2022. Analyses were primarily descriptive and included a comparison between hospitals with and without an OPAT program. Sixty of the 71 hospitals (84.5%) responded. Fifty-five (91.7%) performed OPAT, with a median number of 20.8 (interquartile range [IQR] 10.3-29.7) patients per 100 hospital beds per year. Of these 55 hospitals, 31 (56.4%) had selection criteria for OPAT and 34 (61.8%) had a protocol for laboratory follow-up. Sixteen hospitals (29.1%) offered self-administered OPAT (S-OPAT), with a median percentage of 5.0% of patients (IQR: 2.3%-10.0%) actually performing self-administration. Twenty-five hospitals (45.5%) had an OPAT-related outcome registration. The presence of an OPAT program (22 hospitals, 40.0%) was significantly associated with aspects of well-organised OPAT care. The most commonly experienced barriers to OPAT implementation were a lack of financial, administrative, and IT support and insufficient time of healthcare staff. Concluding, hospital-initiated OPAT is widely available in the Netherlands, but various aspects of well-organised OPAT care can be improved. Implementation of a team-based OPAT program can contribute to such improvements. The observed variation provides leads for further scientific research, guidelines, and practical implementation programs.
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Affiliation(s)
- Hester H. Stoorvogel
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Internal Medicine & IQ Healthcare, Radboud Center for Infectious Diseases, 6500HB Nijmegen, The Netherlands
- Correspondence:
| | - Marlies E. J. L. Hulscher
- Radboud University Medical Center, Department of IQ Healthcare, Radboud Center for Infectious Diseases, 6500HB Nijmegen, The Netherlands
| | - Heiman F. L. Wertheim
- Radboud University Medical Center, Department of Medical Microbiology, Radboud Center for Infectious Diseases, 6500HB Nijmegen, The Netherlands
| | - Ed P. F. Yzerman
- ABR Zorgnetwerk Noord-Holland–Flevoland, 1105AZ Amsterdam, The Netherlands
| | - Maarten Scholing
- ABR Zorgnetwerk Noord-Holland–Flevoland, 1105AZ Amsterdam, The Netherlands
- OLVG Lab BV, 1091AC Amsterdam, The Netherlands
| | - Jeroen A. Schouten
- Radboud University Medical Center, Department of Intensive Care & IQ Healthcare, Radboud Center for Infectious Diseases, 6500HB Nijmegen, The Netherlands
| | - Jaap ten Oever
- Radboud University Medical Center, Department of Internal Medicine, Radboud Center for Infectious Diseases, 6500HB Nijmegen, The Netherlands
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22
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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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23
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Attwood LO, McKechnie M, Vujovic O, Higgs P, Lloyd‐Jones M, Doyle JS, Stewardson AJ. Review of management priorities for invasive infections in people who inject drugs: highlighting the need for patient-centred multidisciplinary care. Med J Aust 2022; 217:102-109. [PMID: 35754144 PMCID: PMC9539935 DOI: 10.5694/mja2.51623] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/18/2022] [Accepted: 05/30/2022] [Indexed: 09/26/2023]
Abstract
There has been a global increase in the burden of invasive infections in people who inject drugs (PWID). It is essential that patient-centred multidisciplinary care is provided in the management of these infections to engage PWID in care and deliver evidence-based management and preventive strategies. The multidisciplinary team should include infectious diseases, addictions medicine (inclusive of alcohol and other drug services), surgery, psychiatry, pain specialists, pharmacy, nursing staff, social work and peer support workers (where available) to help address the comorbid conditions that may have contributed to the patient's presentation. PWID have a range of antimicrobial delivery options that can be tailored in a patient-centred manner and thus are not limited to prolonged hospital admissions to receive intravenous antimicrobials for invasive infections. These options include discharge with outpatient parenteral antimicrobial therapy, long-acting lipoglycopeptides (dalbavancin and oritavancin) and early oral antimicrobials. Open and respectful discussion with PWID including around harm reduction strategies may decrease the risk of repeat presentations with injecting-related harms.
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Affiliation(s)
| | | | - Olga Vujovic
- Alfred HealthMelbourneVIC
- Monash UniversityMelbourneVIC
| | - Peter Higgs
- Burnet InstituteMelbourneVIC
- La Trobe UniversityMelbourneVIC
| | | | - Joseph S Doyle
- Alfred HealthMelbourneVIC
- Monash UniversityMelbourneVIC
- Burnet InstituteMelbourneVIC
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Montalto M, Ko SQ. Telling the difference and the telling differences between hospital in the home and outpatient parenteral antibiotic therapy. Intern Med J 2022; 52:880-884. [PMID: 35538016 DOI: 10.1111/imj.15780] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 11/27/2022]
Abstract
Doctors, authors, funders and hospital managers should take care to distinguish the important differences between hospital in the home (HIH) and outpatient parenteral antimicrobial therapy (OPAT) services. HIH is an inpatient service delivered at home usually by (or on behalf of) hospitals, which aims to substitute for a traditional inpatient stay. It does so by delivering a wide range of hospital treatments to patients at home, or residential aged care, using hospital medical and nursing staff, delivery technologies and venous access, pharmacy, radiology and pathology, and a structured system of on call and governance. OPAT is an outpatient service, usually run through infectious diseases physicians' offices or departments. Most care is delivered in infusion centres and requires patients to travel for their care. Generally, there is no after-hours support. HIH has supplanted the role of OPAT due to improved governance and a wider clinical and severity scope. HIH is accessible from hospital emergency departments or directly from residential aged care facilities. Inpatient capacity has been expanded during the COVID-19 pandemic. There is evidence that both HIH and OPAT can successfully treat their selected patient groups. There are no head-to-head studies, but in observational comparisons there might be more adverse drug events in OPAT. OPAT places a greater onus of care, supervision and travel needs on the patient and family. Where HIH is not available, OPAT may remain an alternative for some patients. However, HIH seeks to redefine the delivery of inpatient care away from the location of care.
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Affiliation(s)
- Michael Montalto
- Hospital in the Home Unit, Epworth Health Care, Melbourne, Victoria, Australia
| | - Stephanie Q Ko
- Department of Medicine, National University Hospital, Singapore
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25
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Keller SC, Salinas A, Gurses AP, Levering M, Hohl D, Hirsch D, Grimes M, Ziemba K, Cosgrove SE. Implementing a Toolkit to Improve the Education of Patients on Home-based Outpatient Parenteral Antimicrobial Therapy (OPAT). Jt Comm J Qual Patient Saf 2022; 48:468-474. [PMID: 35850954 PMCID: PMC10184031 DOI: 10.1016/j.jcjq.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients discharged to the home on home-based outpatient parenteral antimicrobial therapy (OPAT) perform their own infusions and catheter care; thus, they require high-quality training to improve safety and the likelihood of treatment success. This article describes the study team's experience piloting an educational toolkit for patients on home-based OPAT. METHODS An OPAT toolkit was developed to address barriers such as unclear communication channels, rushed instruction, safe bathing with an intravenous (IV) catheter, and lack of standardized instructions. The research team evaluated the toolkit through interviews with home infusion nurses implementing the intervention, surveys of 20 patients who received the intervention, and five observations of the home infusion nurses delivering the intervention to patients and caregivers. RESULTS Of surveyed patients, 90.0% were comfortable infusing medications at the time of discharge, and 80.0% with bathing with the IV catheter. While all practiced on equipment, 75.0% used the videos and the paper checklists. Almost all (95.0%) were satisfied with their training, and all were satisfied with managing their IV catheters at home. The videos were considered very helpful, particularly as reference. Overall, nurses adjusted training to patient characteristics and modified the toolkit over time. Shorter instruction forms were more helpful than longer instruction forms. CONCLUSION Developing a toolkit to improve the education of patients on home-based OPAT has the potential to improve the safety of and experience with home-based OPAT.
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Krieg VM, Brandes V, Lindemann C, Moll FH, Leißner J. [Rare etiology of a perinephric abscess]. Urologe A 2022; 61:986-991. [PMID: 35403896 PMCID: PMC8995691 DOI: 10.1007/s00120-022-01808-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Victoria Margaux Krieg
- Urologische Klinik, Kliniken der Stadt Köln gGmbH, Neufelder Str. 32, 51067, Köln, Deutschland.
| | - Vanessa Brandes
- Medizinische Fakultät und Universitätsklinikum Köln, Klinik I für Innere Medizin, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Christoph Lindemann
- Klinik II für Innere Medizin und Center for Molecular Medicine Cologne, (CMMC), Medizinische Fakultät und Universitätsklinikum Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Friedrich H Moll
- Urologische Klinik, Kliniken der Stadt Köln gGmbH, Neufelder Str. 32, 51067, Köln, Deutschland
- Institut für Geschichte, Theorie und Ethik der Medizin, Centre for Health and Society Heinrich-Heine-Universität, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Joachim Leißner
- Urologische Klinik, Kliniken der Stadt Köln gGmbH, Neufelder Str. 32, 51067, Köln, Deutschland
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Al Shareef HJ, Al Harbi A, Alatawi Y, Aljabri A, Al-Ghanmi MA, Alzahrani MS, Algarni MA, Khobrani A, Haseeb A, AlSenani F, Elrggal ME. Evaluate the Effectiveness of Outpatient Parenteral Antimicrobial Therapy (OPAT) Program in Saudi Arabia: A Retrospective Study. Antibiotics (Basel) 2022; 11:antibiotics11040441. [PMID: 35453192 PMCID: PMC9026843 DOI: 10.3390/antibiotics11040441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 12/04/2022] Open
Abstract
(1) Background: Outpatient parenteral antibiotic therapy (OPAT) is a well-established and cost-effective measure that improves the efficient use of healthcare resources and increases bed availability. Only limited published data is available to illustrate OPAT implementation and outcomes in Saudi Arabia. The main objective of this study was to evaluate the effectiveness of OPAT in a tertiary center in Saudi Arabia. (2) Methods: In this retrospective study, clinical charts of enrolled patients were reviewed in a tertiary care center from the initial month of November 2017 to March 2020. All admitted patients with a central line and who enrolled in the OPAT of the hospital during this study period were included. The primary outcome was the 30-days readmission rate of OPAT patients. Secondary outcomes were factors associated with OPAT failure. Descriptive analysis of the data was used to express the results. (3) Results: We enrolled 90 patients; 54 (60%) were male; the mean age was 55.16 (±17.7) years old. The mean duration of the antimicrobial treatment was 21.9 (+24.6) days. All patients completed the intended course of therapy. Ertapenem was the most frequently used antimicrobial (43%), followed by vancomycin (11.2%). Urinary tract infections (UTIs) are some of the most common bacterial infections in 25 patients (26.9%), followed by osteomyelitis in 16 patients (17.2%). Extended-spectrum beta-lactamase E.coli was the highest common isolated microorganism (44.9%), followed by methicillin-resistant Staphylococcus aureus MRSA (16.9%). The readmission to the hospital during therapy was required for 12 patients (13.3%). Shifting from hospital care to OPAT care resulted in cost savings of 18 million SAR in the overall assessment period and avoided a total of 1984 patient days of hospitalization. (4) Conclusion: The findings have shown that OPAT therapy was effective with minimum hospital readmissions and therapy complications. OPAT programs can reduce healthcare costs and should be integrated into practice.
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Affiliation(s)
- Haneen J. Al Shareef
- Clinical Pharmacy, King Abdullah Medical City, Makkah 21955, Saudi Arabia; (H.J.A.S.); (M.A.A.-G.); (A.K.)
| | - Adnan Al Harbi
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia; (A.A.H.); (A.H.); (F.A.)
| | - Yasser Alatawi
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk 71491, Saudi Arabia;
| | - Ahmed Aljabri
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Mohammed A. Al-Ghanmi
- Clinical Pharmacy, King Abdullah Medical City, Makkah 21955, Saudi Arabia; (H.J.A.S.); (M.A.A.-G.); (A.K.)
| | - Mohammed S. Alzahrani
- Clinical Pharmacy Department, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia; (M.S.A.); (M.A.A.)
| | - Majed Ahmed Algarni
- Clinical Pharmacy Department, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia; (M.S.A.); (M.A.A.)
| | - Attiah Khobrani
- Clinical Pharmacy, King Abdullah Medical City, Makkah 21955, Saudi Arabia; (H.J.A.S.); (M.A.A.-G.); (A.K.)
| | - Abdul Haseeb
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia; (A.A.H.); (A.H.); (F.A.)
| | - Faisal AlSenani
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia; (A.A.H.); (A.H.); (F.A.)
| | - Mahmoud E. Elrggal
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia; (A.A.H.); (A.H.); (F.A.)
- Correspondence: or
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Sacranie Y, Fleming N, Smith W. P08 The quality of life and cost benefits of domiciliary 24-hour piperacillin/tazobactam 13.5 g infusion in patients with necrotizing otitis externa. JAC Antimicrob Resist 2022. [PMCID: PMC8849336 DOI: 10.1093/jacamr/dlac004.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The incidence of necrotizing otitis externa (NOE) is increasing with the rise in the population who are elderly or immunocompromised. Currently there is no consensus on an antibiotic regimen for NOE but in a recent survey of otolaryngologists, 90% recommended using IV antibiotics.1,2 An initial 6 week period of IV antibiotics such as piperacillin/tazobactam has been recommended, this necessitated a prolonged hospital stay in patients who could be managed at home. To enable domiciliary treatment, a patient pathway was set-up, a ‘mid-line’ inserted and once clinically well (after 0–10 days in hospital) home antibiotic treatment was commenced.
Objectives
To evaluate the patient satisfaction, safety and cost benefit of using 6 weeks of domiciliary piperacillin/tazobactam 13.5 g administered with infusion pump in patients with NOE.
Methods
Since September 2017 to present, 11 patients (9 males, 2 females aged 52–91 years) received domiciliary IV antibiotics for NOE, patients completed a patient satisfaction questionnaire [Glasgow Benefit Inventory (GBI), a validated questionnaire that is used to assess the impact of any clinical intervention]. The cost of this service was compared with the traditional 6 week stay in hospital for IV antibiotic therapy. Patients were only asked to complete the GBI to evaluate a recognized treatment.
Results
The GBI scale ranges from −100 (maximal negative benefit) to 0 (no benefit), to +100 (maximal benefit). Table 1 demonstrates that domiciliary IV antibiotics have a positive impact on total and general health but the low scores for social and physical health reflect worsening of quality of life in patients with NOE. All patients expressed they preferred being at home rather than being in hospital. 6 weeks inpatient care (at £250 per night) equates to £10 500 per patient. Piperacillin/tazobactam 4.5 g injection, costing £7.85 per ampoule, given thrice daily for 6 weeks costs £989. Domiciliary treatment using piperacillin/tazobactam 13.5 g infusion device is £98.16 daily, 6 weeks antibiotic costs £4122 per patient. A domiciliary nurse visit is £120 equates to nursing costs of £5040 for antibiotic given by infusion. Domiciliary potentially saves £2327 per patient.
Conclusions
Although studies have assessed community IV antibiotic service;3 this study albeit with limited patient numbers is the first evaluating patient satisfaction and cost benefit of domiciliary antibiotics in patients with NOE. All patients preferred to be treated at home with no safety issues raised. There is a potential saving of £2347 per patient with domiciliary rather than in-patient treatment as well as ‘freeing-up’ beds for other patients requiring admission.
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Affiliation(s)
- Y. Sacranie
- Kettering General Hospital NHS Trust, Kettering, Northamptonshire, NN16 8UZ, UK
| | - N. Fleming
- Kettering General Hospital NHS Trust, Kettering, Northamptonshire, NN16 8UZ, UK
| | - W. Smith
- Kettering General Hospital NHS Trust, Kettering, Northamptonshire, NN16 8UZ, UK
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Emilie C, De Nocker P, Saïdani N, Gilchrist M, Seaton RA, Patel S, Beraud G, Kofteridis D, Schouten J, Thilly N, Berrevoets M, Hulscher M, Buyle F, Pulcini C. Survey of delivery of parenteral antimicrobials in non-inpatient settings across Europe. Int J Antimicrob Agents 2022; 59:106559. [DOI: 10.1016/j.ijantimicag.2022.106559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 01/23/2022] [Accepted: 02/20/2022] [Indexed: 11/05/2022]
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Adams JW, Savinkina A, Hudspeth JC, Gai MJ, Jawa R, Marks LR, Linas BP, Hill A, Flood J, Kimmel S, Barocas JA. Simulated Cost-effectiveness and Long-term Clinical Outcomes of Addiction Care and Antibiotic Therapy Strategies for Patients With Injection Drug Use-Associated Infective Endocarditis. JAMA Netw Open 2022; 5:e220541. [PMID: 35226078 PMCID: PMC8886538 DOI: 10.1001/jamanetworkopen.2022.0541] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/10/2022] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Emerging evidence supports the use of outpatient parenteral antimicrobial therapy (OPAT) and, in many cases, partial oral antibiotic therapy for the treatment of injection drug use-associated infective endocarditis (IDU-IE); however, long-term outcomes and cost-effectiveness remain unknown. OBJECTIVE To compare the added value of inpatient addiction care services and the cost-effectiveness and clinical outcomes of alternative antibiotic treatment strategies for patients with IDU-IE. DESIGN, SETTING, AND PARTICIPANTS This decision analytical modeling study used a validated microsimulation model to compare antibiotic treatment strategies for patients with IDU-IE. Model inputs were derived from clinical trials and observational cohort studies. The model included all patients with injection opioid drug use (N = 5 million) in the US who were eligible to receive OPAT either in the home or at a postacute care facility. Costs were annually discounted at 3%. Cost-effectiveness was evaluated from a health care sector perspective over a lifetime starting in 2020. Probabilistic sensitivity, scenario, and threshold analyses were performed to address uncertainty. INTERVENTIONS The model simulated 4 treatment strategies: (1) 4 to 6 weeks of inpatient intravenous (IV) antibiotic therapy along with opioid detoxification (usual care strategy), (2) 4 to 6 weeks of inpatient IV antibiotic therapy along with inpatient addiction care services that offered medication for opioid use disorder (usual care/addiction care strategy), (3) 3 weeks of inpatient IV antibiotic therapy along with addiction care services followed by OPAT (OPAT strategy), and (4) 3 weeks of inpatient IV antibiotic therapy along with addiction care services followed by partial oral antibiotic therapy (partial oral antibiotic strategy). MAIN OUTCOMES AND MEASURES Mean percentage of patients completing treatment for IDU-IE, deaths associated with IDU-IE, life expectancy (measured in life-years [LYs]), mean cost per person, and incremental cost-effectiveness ratios (ICERs). RESULTS All modeled scenarios were initialized with 5 million individuals (mean age, 42 years; range, 18-64 years; 70% male) who had a history of injection opioid drug use. The usual care strategy resulted in 18.63 LYs at a cost of $416 570 per person, with 77.6% of hospitalized patients completing treatment. Life expectancy was extended by each alternative strategy. The partial oral antibiotic strategy yielded the highest treatment completion rate (80.3%) compared with the OPAT strategy (78.8%) and the usual care/addiction care strategy (77.6%). The OPAT strategy was the least expensive at $412 150 per person. Compared with the OPAT strategy, the partial oral antibiotic strategy had an ICER of $163 370 per LY. Increasing IDU-IE treatment uptake and decreasing treatment discontinuation made the partial oral antibiotic strategy more cost-effective compared with the OPAT strategy. When assuming that all patients with IDU-IE were eligible to receive partial oral antibiotic therapy, the strategy was cost-saving and resulted in 0.0247 additional discounted LYs. When treatment discontinuation was decreased from 3.30% to 2.65% per week, the partial oral antibiotic strategy was cost-effective compared with OPAT at the $100 000 per LY threshold. CONCLUSIONS AND RELEVANCE In this decision analytical modeling study, incorporation of OPAT or partial oral antibiotic approaches along with addiction care services for the treatment of patients with IDU-IE was associated with increases in the number of people completing treatment, decreases in mortality, and savings in cost compared with the usual care strategy of providing inpatient IV antibiotic therapy alone.
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Affiliation(s)
- Joëlla W. Adams
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
- RTI International, Research Triangle Park, North Carolina
| | - Alexandra Savinkina
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - James C. Hudspeth
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Mam Jarra Gai
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Raagini Jawa
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Laura R. Marks
- Division of Infectious Diseases, School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Benjamin P. Linas
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Alison Hill
- Population Health Analytics Division, Boston Medical Center, Boston, Massachusetts
| | - Jason Flood
- Population Health Analytics Division, Boston Medical Center, Boston, Massachusetts
| | - Simeon Kimmel
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Section of General Medicine, Boston Medical Center, Boston, Massachusetts
| | - Joshua A. Barocas
- Division of General Internal Medicine, Anschutz Medical Campus, University of Colorado, Aurora
- Division of Infectious Diseases, Anschutz Medical Campus, University of Colorado, Aurora
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Efficacy and safety of home-based intravenous antibiotic therapy among adults: a systematic review. Int J Antimicrob Agents 2022; 59:106555. [DOI: 10.1016/j.ijantimicag.2022.106555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/02/2022] [Accepted: 02/12/2022] [Indexed: 11/18/2022]
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Huggins CE, Park TE, Boateng E, Zeana C. The Impact of a Standardized Discharge Process on 30-Day Readmissions for Patients on Outpatient Parenteral Antibiotic Treatment. Hosp Pharm 2022; 57:107-111. [PMID: 35521026 PMCID: PMC9065516 DOI: 10.1177/0018578720985434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Introduction: Outpatient parenteral antibiotic treatment (OPAT) is associated with shorter length of hospital stay and reduced cost. Yet, patients discharged home on OPAT are at risk of hospital readmissions due to adverse events and complications. Although the impact of a multidisciplinary approach to readmission has been assessed by previous studies, addition of an innovative technology has not been evaluated for OPAT. This study examines the impact of a multidisciplinary approach including automated voice calls on 30-day readmissions of OPAT patients. Methods: A post-discharge transitional care process (PDTCP) targeting OPAT patients was implemented in fall 2016. This process included an automated telephone patient engagement service and coordination among pharmacy, nursing, medicine, and social work personnel. The patients on OPAT received automated telephone calls at 2, 9, 16, 28, and 40 days post-discharge to ensure medication availability and adherence and to circumvent issues that would otherwise result in an emergency room visit or readmission to the hospital. Results: A total 429 voice calls were made to 148 patients from November 8, 2016 to February 28, 2019. Overall, 61% (n = 90/148) of the patients were successfully reached by the automated voice system. The patients who were reached by the automated voice system were less likely to be readmitted than those not reached (18.9% vs 41.4%; relative risk (RR) 0.46, 95% CI 0.27-0.77, P = .003). Conclusion: Our study demonstrated that a multidisciplinary approach involving the use of automated telephone calls was associated with decreased hospital readmissions.
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Affiliation(s)
- Charnicia E. Huggins
- BronxCare Health System, Bronx, NY, USA,Charnicia E. Huggins, Pharmacy Department, BronxCare Health System, 1650 Grand Concourse Bronx, Bronx, NY 10457, USA.
| | - Tae Eun Park
- Formerly of BronxCare Health System, Bronx, NY, USA
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Browning S, Loewenthal MR, Freelander I, Dobson PM, Schneider K, Davis JS. Safety of prolonged outpatient courses of intravenous antibiotics: a prospective cohort study. Clin Microbiol Infect 2022; 28:832-837. [PMID: 35017063 DOI: 10.1016/j.cmi.2021.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/20/2021] [Accepted: 12/25/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The perceived need for prolonged intravenous antibiotic courses has become a major driver behind the growth of outpatient parenteral antimicrobial therapy (OPAT) services. Several recent randomised controlled trials demonstrate non-inferiority of early switch to oral therapy and highlight the need to accurately quantify harms associated with OPAT. METHODS We conducted a 10-year prospective cohort study in a tertiary hospital OPAT service. Adults admitted to the service between 1st June 2009 and 30th June 2019 who received an intravenous antimicrobial agent were included. Adverse events (AEs) attributable to intravenous antibiotics or intravenous access were recorded in a prospectively maintained database and analysed. RESULTS There were 4,160 admissions (median length of stay 20 days), and a total of 88,432 patient-days of observation. 135 (3.3% of admissions) experienced at least one major AE (1.54/1,000 patient days [95%CI: 1.29 to 1.82]). The risk of a major AE peaked in the second week of OPAT admission, with acute kidney injury (43/136, 32%) and severe cytopenia (42/136, 31%) being most common. At least one minor AE occurred in 38.3% (1,592/4,160) of admissions (26.4 per 1,000 patient days [95%CI: 25.4 to 27.5]), with central venous catheter related complications accounting for 71% (1658/2338). CONCLUSIONS The incidence of major adverse events during long courses of intravenous antibiotics is low, peaking in week two and tailing off thereafter. These results should inform decisions concerning the choice of intravenous versus oral antimicrobials.
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Affiliation(s)
- S Browning
- Department of Infectious Diseases, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - M R Loewenthal
- Department of Infectious Diseases, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - I Freelander
- Department of Infectious Diseases, John Hunter Hospital, Newcastle, NSW, Australia
| | - P M Dobson
- Department of Infectious Diseases, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - K Schneider
- Department of Infectious Diseases, John Hunter Hospital, Newcastle, NSW, Australia
| | - J S Davis
- Department of Infectious Diseases, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia; Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
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Fanucchi LC, Murphy SM, Surratt H, Kapadia SN, Walsh SL, Grubbs JA, Thornton AC, Nuzzo P, Lofwall MR. Design and protocol of the Buprenorphine plus Outpatient Parenteral Antimicrobial Therapy (B-OPAT) study: a randomized clinical trial of integrated outpatient treatment of opioid use disorder and severe, injection-related infections. Ther Adv Infect Dis 2022; 9:20499361221108005. [PMID: 35847566 PMCID: PMC9277431 DOI: 10.1177/20499361221108005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/01/2022] [Indexed: 02/06/2023] Open
Abstract
Introduction A marked increase in hospitalizations for severe, injection-related infections (SIRI) has been associated with the opioid epidemic. Outpatient parenteral antibiotic therapy (OPAT) is typically not offered to persons with opioid use disorder (OUD) and SIRI, though increasing evidence suggests it may be feasible and safe. This study evaluates the efficacy and cost-effectiveness of an integrated care model combining Buprenorphine treatment of OUD with OPAT for SIRI (B-OPAT) compared with treatment as usual on key OUD, infectious disease, and health economic outcomes. B-OPAT expands and incorporates key elements of established clinical models, including inpatient initiation of buprenorphine for OUD, inpatient infectious disease consultation for SIRI, office-based treatment of OUD, and OPAT, and includes more frequent clinical outpatient visits than standard OPAT. A qualitative evaluation is included to contextualize effectiveness outcomes and identify barriers and facilitators to intervention adoption and implementation. Methods B-OPAT is a single-site, randomized, parallel-group, superiority trial recruiting 90 adult inpatients hospitalized with OUD and SIRI who require at least 2 weeks of intravenous (IV) antibiotic therapy. After screening, eligible participants are randomized 1:1 to either discharge once medically stable to an integrated outpatient treatment care model combining Buprenorphine and OPAT (B-OPAT) or to Treatment As Usual (TAU). The primary outcome measure is the proportion of urine samples negative for illicit opioids in the 12 weeks after discharge from the hospital. Key secondary OUD outcomes include self-reported number of days of illicit opioid abstinence and 12-week retention in buprenorphine treatment. The infection outcomes are completion of recommended IV antibiotic therapy, peripherally inserted central catheter (PICC) complications, and readmission related to primary SIRI. Conclusions The B-OPAT study will help address the important question of whether it is clinically effective and cost-effective to discharge persons with OUD and SIRI to an integrated outpatient care model combining OUD treatment with OPAT relative to TAU (Clinicaltrials.gov Identifier: NCT04677114).
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Affiliation(s)
- Laura C. Fanucchi
- Division of Infectious Diseases, College of
Medicine, University of Kentucky, 845 Angliana Ave., Lexington, KY, 40508,
USA
- Center on Drug and Alcohol Research, College of
Medicine, University of Kentucky, Lexington, KY, USA
| | - Sean M. Murphy
- Department of Population Health Sciences, Weill
Cornell Medicine, New York, NY, USA
| | - Hilary Surratt
- Center on Drug and Alcohol Research, College of
Medicine, University of Kentucky, Lexington, KY, USA
- Department of Behavioral Science, College of
Medicine, University of Kentucky, Lexington, KY, USA
| | - Shashi N. Kapadia
- Department of Population Health Sciences, Weill
Cornell Medicine, New York, NY, USA
- Division of Infectious Diseases, Weill Cornell
Medicine, New York, NY, USA
| | - Sharon L. Walsh
- Center on Drug and Alcohol Research, College of
Medicine, University of Kentucky, Lexington, KY, USA
- Departments of Behavioral Science and
Psychiatry, College of Medicine, University of Kentucky, Lexington, KY,
USA
- Department of Pharmaceutical Sciences, College
of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - James A. Grubbs
- Division of Infectious Diseases, College of
Medicine, University of Kentucky, Lexington, KY, USA
| | - Alice C. Thornton
- Division of Infectious Diseases, College of
Medicine, University of Kentucky, Lexington, KY, USA
| | - Paul Nuzzo
- Center on Drug and Alcohol Research, College
of Medicine, University of Kentucky, Lexington, KY, USA
| | - Michelle R. Lofwall
- Center on Drug and Alcohol Research, College
of Medicine, University of Kentucky, Lexington, KY, USA
- Departments of Behavioral Science and
Psychiatry, College of Medicine, University of Kentucky, Lexington, KY,
USA
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Fernández-Rubio B, del Valle-Moreno P, Herrera-Hidalgo L, Gutiérrez-Valencia A, Luque-Márquez R, López-Cortés LE, Gutiérrez-Urbón JM, Luque-Pardos S, Fernández-Polo A, Gil-Navarro MV. Stability of Antimicrobials in Elastomeric Pumps: A Systematic Review. Antibiotics (Basel) 2021; 11:antibiotics11010045. [PMID: 35052921 PMCID: PMC8772931 DOI: 10.3390/antibiotics11010045] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 02/07/2023] Open
Abstract
Outpatient parenteral antimicrobial therapy (OPAThttp) programs have become an important healthcare tool around the world. Portable elastomeric infusion pumps are functional devices for ambulatory delivery of antimicrobial drugs, and their stability is an essential point to guarantee an appropriate infusion administration. We conducted a systematic review to provide a synthesis and a critical evaluation of the current evidence regarding antimicrobial stability in elastomeric pumps. Data sources were PubMed, EMBASE, and Web of Sciences. The review protocol was registered on the Center for Open Science, and it was carried out following the PRISMA guidelines. Studies were eligible if the aim was the evaluation of the physicochemical stability of an antimicrobial agent stored in an elastomeric device. Of the 613 papers identified, 33 met the inclusion criteria. The most studied group of antimicrobials was penicillins, followed by cephalosporins and carbapenems. In general, the stability results of the antimicrobials that have been studied in more than one article agree with each other, with the exception of ampicillin, flucloxacillin, and ceftazidime. The antibiotics that displayed a longer stability were glycopeptides and clindamycin. Regarding the stability of antifungals and antivirals, only caspofungin, voriconazole, and ganciclovir have been investigated. The information provided in this article should be considered in patient treatments within the OPAT setting. Further stability studies are needed to confirm the appropriate use of the antimicrobials included in this program to ensure optimal patient outcomes.
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Affiliation(s)
- Beatriz Fernández-Rubio
- Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain; (B.F.-R.); (P.d.V.-M.)
| | - Paula del Valle-Moreno
- Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain; (B.F.-R.); (P.d.V.-M.)
| | - Laura Herrera-Hidalgo
- Unidad de Gestión Clínica de Farmacia, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, 41013 Seville, Spain;
- Correspondence: ; Tel.: +34-955-012-095
| | - Alicia Gutiérrez-Valencia
- Infección por el VIH y Farmacocinética de Antivirals, Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain;
| | - Rafael Luque-Márquez
- Unidad de Gestión Clinica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, 41013 Seville, Spain;
| | - Luis E. López-Cortés
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen Macarena/CSIC/, 41013 Seville, Spain;
| | - José María Gutiérrez-Urbón
- Unidad de Gestión Clínica de Farmacia, Complexo Hospitalario Universitario de A Coruña, 15006 A Coruna, Spain;
| | - Sonia Luque-Pardos
- Unidad de Gestión Clínica de Farmacia, Hospital del Mar, 08003 Barcelona, Spain;
| | - Aurora Fernández-Polo
- Servicio de Farmacia, Proa-NEN, Hospital Infantil, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain;
| | - María V. Gil-Navarro
- Unidad de Gestión Clínica de Farmacia, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, 41013 Seville, 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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Dimitrova M, Gilchrist M, Seaton RA. Outpatient parenteral antimicrobial therapy (OPAT) versus inpatient care in the UK: a health economic assessment for six key diagnoses. BMJ Open 2021; 11:e049733. [PMID: 34588251 PMCID: PMC8479950 DOI: 10.1136/bmjopen-2021-049733] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To compare costs associated with different models of outpatient parenteral antimicrobial therapy (OPAT) delivery with costs of inpatient (IP) care across key infection groups managed via OPAT in the UK. DESIGN A cost-minimisation design was used due to evidence of similarities in patient and treatment outcomes between OPAT and IP care. A bottom-up approach was undertaken for the evaluation of OPAT associated costs. The British Society of Antimicrobial Chemotherapy National Outcomes Registry System was used to determine key infection diagnoses, mean duration of treatment and most frequent antibiotics used. SETTING Several OPAT delivery settings were considered and compared with IP care. INTERVENTIONS OPAT models considered were OP clinic model, nurse home visits, self (or carer)-administration by a bolus intravenous, self-administration by a commercially prefilled elastomeric device, continuous intravenous infusion of piperacillin with tazobactam or flucloxacillin with elastomeric device as OP once daily and, specifically for bone and joint and diabetic foot infections, complex outpatient oral antibiotic therapies. RESULTS Base case and a range of scenario results showed all evaluated OPAT service delivery models to be less costly than IP stay of equivalent duration. The extent of savings varied by OPAT healthcare delivery models. Estimated OPAT costs as a proportion of IP costs were estimated at 0.23-0.53 (skin and soft-tissue infections), 0.34-0.46 (complex urinary tract infections), 0.23-0.51 (orthopaedic infections), 0.24-0.42 (diabetic foot infections) 0.40-0.56 (exacerbations of bronchiectasis) and 0.25-0.42 (intra-abdominal infections). Partial or full complex oral antibiotic therapies in orthopaedic or diabetic foot infections costs were estimated to be 0.13-0.26 of IP costs. Main OPAT costs were associated with staff time and antimicrobial medications. CONCLUSIONS OPAT is a cost-effective use of National Health Service resources for the treatment of a range of infections in the UK in patients who can be safely managed in a non-IP setting.
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Affiliation(s)
- Maria Dimitrova
- Scottish Health Technology Group, Healthcare Improvement Scotland, Edinburgh, UK
| | - Mark Gilchrist
- Department of Infection/Pharmacy, Imperial College Healthcare NHS Trust, London, UK
| | - R A Seaton
- Infectious Diseases, Queen Elizabeth University Hospital, Glasgow, UK
- Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Glasgow, UK
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Wu KH, Sakoulas G, Geriak M. Vancomycin or Daptomycin for Outpatient Parenteral Antibiotic Therapy: Does It Make a Difference in Patient Satisfaction? Open Forum Infect Dis 2021; 8:ofab418. [PMID: 34476284 PMCID: PMC8404740 DOI: 10.1093/ofid/ofab418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
A 5-question telephone survey was administered to compare satisfaction between patients receiving vancomycin vs daptomycin outpatient parenteral antimicrobial therapy (OPAT). Twenty-seven patients completed the survey (40%). Vancomycin had higher daily interference score than daptomycin (P = .03). All patients receiving daptomycin reported a satisfaction score ≥8/10, as compared to 67% of patients who received vancomycin (P < .03). OPAT antibiotics with less cumbersome administration regimens may translate into higher patient satisfaction and quicker return to life normalcy.
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Affiliation(s)
- Katherine H Wu
- Skaggs School of Pharmacy, University of California, San Diego, La Jolla, California, USA
| | - George Sakoulas
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, California, USA.,Sharp Memorial Hospital, San Diego, California, USA
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Krein SL, Harrod M, Weston LE, Garlick BR, Quinn M, Fletcher KE, Chopra V. Comparing peripherally inserted central catheter-related practices across hospitals with different insertion models: a multisite qualitative study. BMJ Qual Saf 2021; 30:628-638. [PMID: 33361343 PMCID: PMC8222389 DOI: 10.1136/bmjqs-2020-011987] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/03/2020] [Accepted: 12/09/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) provide reliable intravenous access for delivery of parenteral therapy. Yet, little is known about PICC care practices or how they vary across hospitals. We compared PICC-related processes across hospitals with different insertion delivery models. METHODS We used a descriptive qualitative methodology and a naturalist philosophy, with site visits to conduct semistructured interviews completed between August 2018 and January 2019. Study sites included five Veterans Affairs Medical Centres, two with vascular access teams (VATs), two with PICC insertion primarily by interventional radiology (IR) and one without on-site PICC insertion capability. Interview participants were healthcare personnel (n=56), including physicians, bedside and vascular access nurses, and IR clinicians. Data collection focused on four PICC domains: use and decision-making process, insertion, in-hospital management and patient discharge education. We used rapid analysis and a summary matrix to compare practices across sites within each domain. RESULTS Our findings highlight the benefits of dedicated VATs across all PICC-related process domains, including implementation of criteria to guide PICC placement decisions, timely PICC insertion, more robust management practices and well-defined patient discharge education. We also found areas with potential for improvement, such as clinician awareness of PICC appropriateness criteria and alternative devices, deployment of VATs and patient discharge education. CONCLUSION Vascular access nurses play critical roles in all aspects of PICC-related care. There is variation in PICC decision-making, care and maintenance, and patient education across hospitals. Quality and safety improvement opportunities to reduce this variation are highlighted.
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Affiliation(s)
- Sarah L Krein
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Molly Harrod
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Lauren E Weston
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Brittani R Garlick
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Martha Quinn
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Kathlyn E Fletcher
- Internal Medicine, Clement J. Zablocki VAMC, Milwaukee, Wisconsin, USA
- Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Vineet Chopra
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Hospital Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Serota DP, Chueng TA, Schechter MC. Applying the Infectious Diseases Literature to People who Inject Drugs. Infect Dis Clin North Am 2021; 34:539-558. [PMID: 32782101 DOI: 10.1016/j.idc.2020.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
People who inject drugs (PWID) presenting with injection drug use-associated infections are an understudied population excluded from most prospective infectious disease (ID) clinical trials. Careful application of the existing ID literature to PWID must consider their unique medical, psychological, and social challenges. Identification and treatment of the underlying substance use disorder are key underpinnings to any successful ID intervention.
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Affiliation(s)
- David P Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 Northwest 14 Street, Suite 851, Miami, FL 33136, USA.
| | - Teresa A Chueng
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 Northwest 14 Street, Suite 851, Miami, FL 33136, USA; Jackson Memorial Hospital, Jackson Health System, Miami, FL, USA. https://twitter.com/teresachueng
| | - Marcos C Schechter
- Division of Infectious Diseases, Department of Medicine, Emory University, 49 Jesse Hill Jr Dr SE, Atlanta, GA 30303, USA. https://twitter.com/limbsandlungs
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Carter B, Fisher-Smith D, Porter D, Lane S, Peak M, Taylor-Robinson D, Bracken L, Carrol ED. Paediatric Outpatient Parenteral Antimicrobial Therapy (OPAT): An e-survey of the experiences of parents and clinicians. PLoS One 2021; 16:e0249514. [PMID: 33798226 PMCID: PMC8018658 DOI: 10.1371/journal.pone.0249514] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 03/20/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Little evidence exists about parental satisfaction and their influence on referral to paediatric Outpatient Parenteral Antimicrobial Therapy (OPAT). AIM This study aimed to examine the experiences of parents, children and clinicians of OPAT at a large tertiary children's hospital. METHOD A prospective e-survey, using closed and open questions, of parents (n = 33) of 33 children who had received OPAT (3 children completed a survey), and clinicians (n = 31) involved in OPAT at a tertiary hospital. Data were collected September 2016 to July 2018. RESULTS Data were analysed using simple descriptive statistics. The results show that OPAT offered benefits (less stress, re-establishment of family life) compared to hospital-based treatment for parents and children, although some were anxious. Clinicians' referral judgements were based on child, home, and clinical factors. Some clinicians found the process of referral complex. CONCLUSION Most parents and children were satisfied with the OPAT service and preferred the option of home-based treatment as it promoted the child's comfort and recovery and supported family routines.
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Affiliation(s)
- Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Debra Fisher-Smith
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
| | - David Porter
- Department of Infectious Diseases and Immunology, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Steven Lane
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Matthew Peak
- Paediatric Medicines Research Unit, Institute in the Park, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - David Taylor-Robinson
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Louise Bracken
- Paediatric Medicines Research Unit, Institute in the Park, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Enitan D. Carrol
- Department of Infectious Diseases and Immunology, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Liverpool Health Partners, Liverpool Science Park, Liverpool, United Kingdom
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García-Queiruga M, Feal Cortizas B, Lamelo Alfonsín F, Pertega Diaz S, Martín-Herranz I. Continuous infusion of antibiotics using elastomeric pumps in the hospital at home setting. REVISTA ESPANOLA DE QUIMIOTERAPIA 2021; 34:200-206. [PMID: 33724755 PMCID: PMC8179936 DOI: 10.37201/req/122.2020] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Introduction To describe the avoided costs and to analyze the effectiveness of intravenous antibiotic treatment in continuous perfusion in patients at Hospital at Home Units (HHU) administered using elastomeric infusion pumps (EIP) prepared in a Hospital Pharmacy Service (HPS). Materials and methods Retrospective observational study of the number and type of EIP prepared in the HPS and of the treated patients. Study period: January 2017-December2018. Analyzed data: demographic data of patients, location of infection, responsible microorganism, medication and type of EIP, dose and duration of treatment and its effectiveness in terms of cure or non-cure or patient’s death. Economic valuation considering: costs of EIP, nursing time needed for preparation and cost of HHU care. Results A total of 1,688 EIP to treat 102 patients resulted in 106 episodes of outpatient treatment of parenteral antibiotic therapy (OPAT) for 1,409 days, thereby avoiding 1,409 days of hospital admission. A total of 59.8% of the patients were men and the mean age was 70.5 ± 17 years. A 31.1% and 68.9% of the cases were empirical and pathogen-directed treatments, respectively. The most used antimicrobials were piperacillin/ tazobactam (42.7%), ceftazidime (24.5%), meropenem (19.8%), ceftolozane/tazobactam (2.8%), and cloxacillin (1.9%). Mean duration of treatment was 13.29 ± 8.60 days. Location of infection: respiratory (42.5%), urinary (17.9%), skin and soft tissue (12.3%), bacteraemia (11.3%), osteomyelitis (7.5%), abdominal (3.8%) and 4.7% in other locations. The cure rate was 84%. Total avoided cost: 580,788.28€ in the 24 months studied. Conclusion This program represents very important economic savings for the health system, and the effectiveness of the antibiotic treatment has not been compromised.
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Affiliation(s)
- M García-Queiruga
- Marta García-Queiruga. Servicio de Farmacia. Complejo Hospitalario Universitario A Coruña. C/ As Xubias 84, 1ª planta. 15006 A Coruña. Spain.
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Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK, Adappa N, Alt JA, Anselmo-Lima WT, Bachert C, Baroody FM, Batra PS, Bernal-Sprekelsen M, Beswick D, Bhattacharyya N, Chandra RK, Chang EH, Chiu A, Chowdhury N, Citardi MJ, Cohen NA, Conley DB, DelGaudio J, Desrosiers M, Douglas R, Eloy JA, Fokkens WJ, Gray ST, Gudis DA, Hamilos DL, Han JK, Harvey R, Hellings P, Holbrook EH, Hopkins C, Hwang P, Javer AR, Jiang RS, Kennedy D, Kern R, Laidlaw T, Lal D, Lane A, Lee HM, Lee JT, Levy JM, Lin SY, Lund V, McMains KC, Metson R, Mullol J, Naclerio R, Oakley G, Otori N, Palmer JN, Parikh SR, Passali D, Patel Z, Peters A, Philpott C, Psaltis AJ, Ramakrishnan VR, Ramanathan M, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Sedaghat AR, Senior BA, Sindwani R, Smith K, Snidvongs K, Stewart M, Suh JD, Tan BK, Turner JH, van Drunen CM, Voegels R, Wang DY, Woodworth BA, Wormald PJ, Wright ED, Yan C, Zhang L, Zhou B. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021; 11:213-739. [PMID: 33236525 DOI: 10.1002/alr.22741] [Citation(s) in RCA: 390] [Impact Index Per Article: 130.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
I. EXECUTIVE SUMMARY BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. METHODS ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. RESULTS ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. CONCLUSION This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.
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Affiliation(s)
| | | | | | | | | | - Amber U Luong
- University of Texas Medical School at Houston, Houston, TX
| | | | - Zachary Soler
- Medical University of South Carolina, Charleston, SC
| | - Kevin C Welch
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Claus Bachert
- Ghent University, Ghent, Belgium.,Karolinska Institute, Stockholm, Sweden.,Sun Yatsen University, Gangzhou, China
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- Columbia University Irving Medical Center, New York, NY
| | - Daniel L Hamilos
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Richard Harvey
- University of New South Wales and Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | | | - Amin R Javer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Kevin C McMains
- Uniformed Services University of Health Sciences, San Antonio, TX
| | | | - Joaquim Mullol
- IDIBAPS Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Alkis J Psaltis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Luke Rudmik
- University of Calgary, Calgary, Alberta, Canada
| | - Raymond Sacks
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - De Yun Wang
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Carol Yan
- University of California San Diego, La Jolla, CA
| | - Luo Zhang
- Capital Medical University, Beijing, China
| | - Bing Zhou
- Capital Medical University, Beijing, China
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Marks M, Bell LCK, Jones I, Rampling T, Kranzer K, Morris-Jones S, Logan S, Pollara G. Clinical and Economic Impact of Implementing OVIVA Criteria on Patients With Bone and Joint Infections in Outpatient Parenteral Antimicrobial Therapy. Clin Infect Dis 2021; 71:207-210. [PMID: 31603189 PMCID: PMC7312207 DOI: 10.1093/cid/ciz991] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/03/2019] [Indexed: 12/17/2022] Open
Abstract
The OVIVA study demonstrated noninferiority for managing bone and joint infections (BJIs) with oral antibiotics. We report that 79.7% of OPAT patients being treated for BJIs at our center would be eligible for oral antibiotics, saving a median (IQR) 19.5 IV-antibiotic days (8.5–37) and GBP 1234 (569–2594) per patient.
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Affiliation(s)
- Michael Marks
- Division of Infection, University College London Hospitals, London, United Kingdom.,Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lucy C K Bell
- Division of Infection, University College London Hospitals, London, United Kingdom
| | - Imogen Jones
- Division of Infection, University College London Hospitals, London, United Kingdom
| | - Tommy Rampling
- Division of Infection, University College London Hospitals, London, United Kingdom
| | - Katharina Kranzer
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Department of Clinical Microbiology, University College London Hospitals, London, United Kingdom
| | - Stephen Morris-Jones
- Department of Clinical Microbiology, University College London Hospitals, London, United Kingdom
| | - Sarah Logan
- Division of Infection, University College London Hospitals, London, United Kingdom
| | - Gabriele Pollara
- Division of Infection, University College London Hospitals, London, United Kingdom.,Division of Infection and Immunity, University College London, London United Kingdom
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Ceniceros AG, Shridhar N, Fazzari M, Felsen U, Fox AD. Low Use of Outpatient Parenteral Antimicrobial Therapy for Drug Use-Associated Infective Endocarditis in an Urban Hospital System. Open Forum Infect Dis 2021; 8:ofab083. [PMID: 33796596 PMCID: PMC7990064 DOI: 10.1093/ofid/ofab083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/12/2021] [Indexed: 01/30/2023] Open
Abstract
Background The opioid crisis in the United States has led to increasing hospitalizations for drug use-associated infective endocarditis (DUA-IE). Outpatient parenteral antimicrobial therapy (OPAT), the preferred modality for intravenous antibiotics for infective endocarditis, has demonstrated similar outcomes among patients with DUA-IE versus non-DUA-IE, but current studies suffer selection bias. The utilization of OPAT for DUA-IE more generally is not well studied. Methods This retrospective cohort study compared OPAT use for DUA-IE versus non-DUA-IE in adults hospitalized between January 1, 2015 and September 1, 2019 at 3 urban hospitals. We used multivariable regression analysis to assess the association between DUA-IE and discharge with OPAT, adjusting for clinically significant covariables. Results The cohort included 518 patients (126 DUA-IE, 392 non-DUA-IE). Compared to those with non-DUA-IE, DUA-IE patients were younger (53.0 vs 68.2 years, P < .001) and more commonly undomiciled (9.5% vs 0.3%, P < .01). Patients with DUA-IE had a significantly lower odds of discharge with OPAT than non-DUA-IE patients (adjusted odds ratio [aOR] = 0.20; 95% confidence interval [CI], 0.10–0.39). Odds of discharge with OPAT remained lower for patients with DUA-IE after excluding undomiciled patients (aOR = 0.22; 95% CI, 0.11–0.43) and those with patient-directed discharges (aOR = 0.27; 95% CI, 0.14–0.52). Conclusions Significantly fewer patients with DUA-IE were discharged with OPAT compared to those with non-DUA-IE, and undomiciled patients or patient-directed discharges did not fully account for this difference. Efforts to increase OPAT utilization among patients with DUA-IE could have important benefits for patients and the healthcare system.
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Affiliation(s)
- Ashley G Ceniceros
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nupur Shridhar
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Melissa Fazzari
- Department of Epidemiology & Population Health (Biostatistics), Albert Einstein College of Medicine, Bronx, New York, USA
| | - Uriel Felsen
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Aaron D Fox
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Boese CK, Lechler P, Frink M, Hackl M, Eysel P, Ries C. [Cost analysis of inpatient versus outpatient intravenous antibiotic treatment for periprosthetic joint infections : A simulation]. DER ORTHOPADE 2021; 50:150-158. [PMID: 32076752 PMCID: PMC7862513 DOI: 10.1007/s00132-020-03889-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hintergrund Die parenterale Antibiotikagabe im Rahmen der Therapie von periprothetischen Infektionen erfordert in der Regel eine stationäre Behandlung und geht mit hohen Kosten einher. Fragestellung Es wurden tatsächliche stationäre Behandlungskosten („inpatient parenteral antibiotic therapy“ [IPAT]) mit simulierten Kosten einer ambulanten Behandlung („outpatient parenteral antibiotic therapy“ [OPAT]) von Patienten mit periprothetischen Gelenkinfektionen verglichen. Die Auswertung erfolgte aus Perspektive der Kostenträger (gesetzliche Krankenversicherung [GKV]) und Leistungserbringer (Krankenhäuser). Material und Methoden Die Analyse und Simulation erfolgten auf Grundlage einer ICD-10 (Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme, 10. Revision) für das Behandlungsjahr 2015 mit der Diagnose T84. Ergebnisse Die simulierte Reduktion von 159 Bettentagen bei den in die Studie eingeschlossenen 12 Patienten erbrachte aus Sicht der Kostenträger eine Reduktion der Gesamtkosten um >18.000 €. Aus Perspektive der Leistungserbringer verbesserte sich der Reinerlös um >22.000 €. Die Gesamtkosten der OPAT für den Kostenträger beliefen sich auf >57.000 €. Für den Leistungserbringer zeigte sich in der Differenz von Poliklinikerlös und -kosten der OPAT ein Verlust von >1500 €. Diskussion Die OPAT ist für Leistungserbringer insgesamt finanziell vorteilhaft. Weitere Vorteile durch Opportunitätskosten erscheinen interessant. Für den Kostenträger ist die OPAT insbesondere durch die ambulanten Medikamentenkosten mit einem finanziellen Mehraufwand verbunden. Der niedergelassene Sektor sollte durch die anzunehmende Mehrbelastung ebenso wie der anzunehmende Patientenkomfort bedacht werden.
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Affiliation(s)
- Christoph Kolja Boese
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinik Köln (AöR), Joseph-Stelzmann-Str. 9, 50924, Köln, Deutschland.
| | - Philipp Lechler
- Klinik für Unfall- und Handchirurgie, Kreiskliniken Altötting, Altötting, Deutschland.,Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg, Marburg, Deutschland
| | - Michael Frink
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg, Marburg, Deutschland
| | - Michael Hackl
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinik Köln (AöR), Joseph-Stelzmann-Str. 9, 50924, Köln, Deutschland
| | - Peer Eysel
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinik Köln (AöR), Joseph-Stelzmann-Str. 9, 50924, Köln, Deutschland
| | - Christian Ries
- Klinik für Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
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Mathur P. COVID-19 and Outpatient Parenteral Antimicrobial Therapy. Ann Intern Med 2021; 174:141-142. [PMID: 33460552 DOI: 10.7326/l20-1346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Pankaj Mathur
- University of Arkansas Medical Sciences and Medical Center, Little Rock, Arkansas
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Abstract
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.
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