1
|
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; 79:2083-2102. [PMID: 38842523 PMCID: PMC11368434 DOI: 10.1093/jac/dkae177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [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.
Collapse
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
| |
Collapse
|
2
|
Négrier L, Mena AM, Dupont C, Gamache P, Zimbril JO, Abdoune Y, Karrout Y, Odou P, Genay S, Décaudin B. The Infusion of Piperacillin/Tazobactam with an Elastomeric Device: A Combined 24-H Stability Study and Drug Solution Flow Rate Analysis. Pharmaceuticals (Basel) 2024; 17:1085. [PMID: 39204190 PMCID: PMC11360378 DOI: 10.3390/ph17081085] [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: 07/08/2024] [Revised: 08/02/2024] [Accepted: 08/12/2024] [Indexed: 09/03/2024] Open
Abstract
Bacterial respiratory tract infections (e.g., in patients with cystic fibrosis) may be treated with the intravenous infusion of a piperacillin/tazobactam (P/T) solution through an elastomeric device. In the present work, we combined a 24-h drug stability study with an assessment of the drug solution flow rate during an in vitro simulated infusion. Experiments were performed in triplicate with two excipient-free generic P/T solutions and an excipient-containing proprietary P/T solution in saline (all 50/6.25 mg/mL) released from an elastomeric infusion device at 32 °C. The P/T solutions' stability was assessed by an HPLC-UV assay, pH and osmolality measurements, a visual assessment, and particle counting. Before these analyses, a forced degradation study was performed. To assess the flow rate, a precision scale was used to weigh the solution collected at the infusion line outlet. The stability criteria were <10% degradation and a flow rate within ± 15% of the nominal value over the 24-h infusion period: all three P/T solutions were found to be stable. The actual flow rate was lower than the expected flow rate; this difference was probably due to the drug solution's high viscosity and must be taken into account in clinical use.
Collapse
Affiliation(s)
- Laura Négrier
- Univ. Lille, CHU Lille, ULR 7365—GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000 Lille, France
| | - Anthony Martin Mena
- Univ. Lille, CHU Lille, ULR 7365—GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000 Lille, France
| | - Christian Dupont
- Hôpital Universitaire Cochin, Assistance Publique—Hôpitaux de Paris, 75014, France—GIFAV—Groupe Interdisciplinaire Francophone sur les Accès Vasculaires, 75014 Paris, France
| | - Philémon Gamache
- Univ. Lille, CHU Lille, ULR 7365—GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000 Lille, France
| | - Jeanne-Olive Zimbril
- Univ. Lille, CHU Lille, ULR 7365—GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000 Lille, France
| | - Yasmine Abdoune
- Univ. Lille, CHU Lille, ULR 7365—GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000 Lille, France
| | - Youness Karrout
- Univ. Lille, INSERM, CHU Lille, U1008, F-59000 Lille, France
| | - Pascal Odou
- Univ. Lille, CHU Lille, ULR 7365—GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000 Lille, France
| | - Stéphanie Genay
- Univ. Lille, CHU Lille, ULR 7365—GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000 Lille, France
| | - Bertrand Décaudin
- Univ. Lille, CHU Lille, ULR 7365—GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000 Lille, France
| |
Collapse
|
3
|
Ferro Rodríguez S, Chantres Legaspi Y, Romay Lema EM, Ayuso García B, Castellano Copa P, Peinó Camba P, Barcia Losada A, Rodríguez Díaz C. [Translated article] Retrospective study of home antibiotic infusion therapy using elastomeric infusion pumps. FARMACIA HOSPITALARIA 2024; 48:T153-T158. [PMID: 38679534 DOI: 10.1016/j.farma.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 12/17/2023] [Accepted: 12/26/2023] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVES To describe the experience of home antibiotic infusion therapy using elastomeric infusion pumps, administered to patients admitted to the Home Hospitalisation Unit of a tertiary hospital for 3 years and to analyse clinical evolution and mortality. METHOD Retrospective observational study. The medical history of the patients included in the study was reviewed. Information was obtained on personal history, antimicrobial therapy received, and clinical evolution. Statistical analysis was performed using SPSS® 19 software. RESULTS 81 patients were included, 61.7% men, with a mean age of 73.5±17.5 years. The most frequent comorbidities were diabetes mellitus (30.9%) and chronic kidney disease (28.4%). Patients received a mean of 11.9±8.5 days of antibiotic treatment in an elastomeric infusion pump. The main focus of infection was respiratory (27.2%), followed by bacteremia (16%) and skin and soft tissue infections (12.3%). Of the infections, 65.4% were monomicrobial, with Pseudomonas aeruginosa being the main microorganism involved (39.6%). The most commonly used antimicrobial was piperacillin/tazobactam (33.3%). The clinical course was good in 85.2% of the patients, but the mortality rate in the 30 days following the end of treatment was 24.7%. In the univariate analysis, a history of neoplasia in the last 5 years (p=.01) and having received fewer days of antibiotic therapy prior to the start of outpatient antimicrobial therapy in infusion pump (p=.04) were associated with worse clinical outcome. Age over 80 years was associated with better outcome (p=.03). The diagnosis of heart failure was associated with higher mortality (p=.026) and patients from surgical services, with lower mortality (p=.047). In the multivariate analysis, the presence of neoplasia was associated with unfavourable evolution (p=.012) and heart failure with higher mortality (p=.027). CONCLUSIONS Outpatient antimicrobial therapy in elastomeric infusion pumps is an alternative in patients requiring prolonged intravenous treatment, and age is not a conditioning factor for inclusion in these programs. However, the presence of certain comorbidities can negatively affect the clinical course and mortality of patients.
Collapse
Affiliation(s)
| | | | - Eva María Romay Lema
- Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario de Lugo, Lugo, Spain
| | - Blanca Ayuso García
- Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario de Lugo, Lugo, Spain
| | | | - Pedro Peinó Camba
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de Lugo, Lugo, Spain
| | - Andrea Barcia Losada
- Servicio de Hospitalización a Domicilio, Complejo Hospitalario Universitario de Lugo, Lugo, Spain
| | - Cristina Rodríguez Díaz
- Servicio de Hospitalización a Domicilio, Complejo Hospitalario Universitario de Lugo, Lugo, Spain
| |
Collapse
|
4
|
Ferro Rodríguez S, Chantres Legaspi Y, Romay Lema EM, Ayuso García B, Castellano Copa P, Peinó Camba P, Barcia Losada A, Rodríguez Díaz C. Retrospective study of home antibiotic infusion therapy in elastomeric infusion pumps. FARMACIA HOSPITALARIA 2024; 48:153-158. [PMID: 38336554 DOI: 10.1016/j.farma.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 12/17/2023] [Accepted: 12/26/2023] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVES To describe the experience of home antibiotic infusion therapy using elastomeric infusion pumps, administered to patients admitted to the Home Hospitalization Unit of a tertiary hospital for three years and to analyse clinical evolution and mortality. METHOD Retrospective observational study. The medical history of the patients included in the study was reviewed. Information was obtained on personal history, antimicrobial therapy received and clinical evolution. Statistical analysis was performed using SPSS® 19 software. RESULTS Eighty-one patients were included, 61.7% men, with a mean age of 73.5 ± 17.5 years. The most frequent comorbidities were diabetes mellitus (30.9%) and chronic kidney disease (28.4%). Patients received a mean of 11.9 ± 8.5 days of antibiotic treatment in an elastomeric infusion pump. The main focus of infection was respiratory (27.2%), followed by bacteremia (16%) and skin and soft tissue infections (12.3%). Of the infections, 65.4% were monomicrobial, with Pseudomonas aeruginosa being the main microorganism involved (39.6%). The most commonly used antimicrobial was piperacillin/tazobactam (33.3%). The clinical course was good in 85.2% of the patients, but the mortality rate in the 30 days following the end of treatment was 24.7%. In the univariate analysis, a history of neoplasia in the last 5 years (p = 0.01) and having received fewer days of antibiotic therapy prior to the start of outpatient antimicrobial therapy in infusion pump (p = 0.04) were associated with worse clinical outcome. Age over 80 years was associated with better outcome (p = 0.03). The diagnosis of heart failure was associated with higher mortality (p = 0.026) and patients from surgical services, with lower mortality (p = 0.047). In the multivariate analysis, the presence of neoplasia was associated with unfavorable evolution (p = 0.012) and heart failure with higher mortality (p = 0.027). CONCLUSIONS Outpatient antimicrobial therapy in elastomeric infusion pumps is an alternative in patients requiring prolonged intravenous treatment, and age is not a conditioning factor for inclusion in these programs. However, the presence of certain comorbidities can negatively affect the clinical course and mortality of patients.
Collapse
Affiliation(s)
- Sara Ferro Rodríguez
- Servicio de Farmacia, Complejo Hospitalario Universitario de Lugo, Lugo, España.
| | | | - Eva María Romay Lema
- Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario de Lugo, Lugo, España
| | - Blanca Ayuso García
- Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario de Lugo, Lugo, España
| | | | - Pedro Peinó Camba
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de Lugo, Lugo, España
| | - Andrea Barcia Losada
- Servicio de Hospitalización a Domicilio, Complejo Hospitalario Universitario de Lugo, Lugo, España
| | - Cristina Rodríguez Díaz
- Servicio de Hospitalización a Domicilio, Complejo Hospitalario Universitario de Lugo, Lugo, España
| |
Collapse
|
5
|
Giuliano G, Tarantino D, Tamburrini E, Nurchis MC, Scoppettuolo G, Raffaelli F. Outpatient parenteral antibiotic therapy (OPAT) through elastomeric continuous infusion pumps in a real-life observational study: Characteristics, safety, and efficacy analysis. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024:S2529-993X(24)00148-5. [PMID: 38902156 DOI: 10.1016/j.eimce.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/02/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION This study aimed to present real-life data on the use, efficacy, and safety of administering antibiotic therapy through portable elastomeric pumps (pEP) in the outpatient setting. METHODS This retrospective observational cohort study was conducted from January 2020 to May 2023 in a large academic hospital in Rome, Italy. All patients receiving antibiotic therapy via pEP were included up to a follow-up period of 90 days after the end of antibiotic therapy. The primary outcome was the treatment response. Secondary endpoints were adverse events attributable to the drug administered, the vascular catheter, or the infection itself. RESULTS Of the 490 patients referred to our outpatient parenteral antibiotic therapy (OPAT) unit, 94 (19.2%) received antibiotic therapy via pEP and were included in the final analysis. The most frequently treated infections were those involving bone and prosthetics, including spondylodiscitis (n=27; 28.8%). Most infections were due to Pseudomonas aeruginosa (n=55; 48.3%). Cefepime (n=32; 34.0%), piperacillin/tazobactam (n=29; 30.9%), ceftolozane/tazobactam (n=7; 7.5%), and oxacillin (n=7; 7.5%) were the most frequently administered antibiotics. The infection cure rate reached 88.3% (n=83). 12 patients (12.8%) reported adverse events, of which half (6.4%) were drug-related and half (6.4%) were line-related. CONCLUSIONS OPAT through portable elastomeric infusion pumps proved to be safe and effective. It also contributed to the reduction of healthcare costs, fully respecting the principles of personalized medicine. This strategy has emerged as a promising tool for antibiotic stewardship and infection control.
Collapse
Affiliation(s)
- Gabriele Giuliano
- UOC Malattie Infettive, Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, Siena, Italy.
| | - Domenico Tarantino
- UOC Farmacia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Enrica Tamburrini
- UOC Malattie Infettive, Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Sezione Malattie Infettive, Dipartimento di sicurezza e bioetica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Mario Cesare Nurchis
- UOC Igiene Ospedaliera, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giancarlo Scoppettuolo
- UOC Malattie Infettive, Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Francesca Raffaelli
- UOC Malattie Infettive, Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| |
Collapse
|
6
|
Di Bella S, Luzzati R, Mearelli F, Papa G, Spazzapan L, Nunnari A, D’Aleo F, Papola C, Principe L. Anti-infective management of infected skin ulcers. LE INFEZIONI IN MEDICINA 2024; 32:138-147. [PMID: 38827836 PMCID: PMC11142418 DOI: 10.53854/liim-3202-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/19/2024] [Indexed: 06/05/2024]
Abstract
Infected skin ulcers represent a frequent and intricate clinical challenge, necessitating prompt and comprehensive multidisciplinary interventions to avert complications. Anti-infective therapy constitutes a cornerstone in the therapeutic paradigm. This manuscript delineates our approach to anti-infective management of infected ulcers, encompassing insights into clinical classifications, diagnostic features, exampless of early clinical decision-making in anti-infective treatment, comprehensive evaluation of infectious diseases encompassing host clinical considerations and potential interventions, determination of antibiotic therapy duration, methodologies for assessing clinical response, identification of potential causes for lack of clinical response, as well as strategies for outpatient parenteral antibiotic therapy and a diagnostic and therapeutic algorithm.
Collapse
Affiliation(s)
- Stefano Di Bella
- Clinical Department of Medical, Surgical, and Health Sciences, Trieste University, Trieste,
Italy
| | - Roberto Luzzati
- Clinical Department of Medical, Surgical, and Health Sciences, Trieste University, Trieste,
Italy
| | - Filippo Mearelli
- Internal Medicine Unit, Trieste University Hospital (ASUGI), Trieste,
Italy
| | - Giovanni Papa
- Clinical Department of Medical, Surgical, and Health Sciences, Trieste University, Trieste,
Italy
| | - Luca Spazzapan
- Plastic Surgery Unit, Trieste University Hospital (ASUGI), Trieste,
Italy
| | - Alessio Nunnari
- Internal Medicine Unit, Trieste University Hospital (ASUGI), Trieste,
Italy
| | - Francesco D’Aleo
- Clinical Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi-Melacrino-Morelli”, Reggio Calabria,
Italy
| | - Carmelo Papola
- Clinical Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi-Melacrino-Morelli”, Reggio Calabria,
Italy
| | - Luigi Principe
- Clinical Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi-Melacrino-Morelli”, Reggio Calabria,
Italy
| |
Collapse
|
7
|
Soni S, Harding I, Jones C, Wade S, Norton J, Pollock JS. A Qualitative Review of Patient Feedback for the OPAT (Outpatient Antimicrobial Therapy) Service in Bristol. Antibiotics (Basel) 2024; 13:420. [PMID: 38786148 PMCID: PMC11117369 DOI: 10.3390/antibiotics13050420] [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: 12/04/2023] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) aims to deliver intravenous antimicrobials to medically stable patients with complex infections outside of a hospital setting. There is good evidence to demonstrate the safety and efficacy of OPAT in the literature. Anecdotally, the feedback from patients has been positive, but only a few studies evaluate this topic in detail. The aim of this qualitative study was to examine patients' experiences with and feedback on the OPAT service in Bristol, United Kingdom, which was established in 2021. A total of 92 patient feedback surveys were reviewed retrospectively, and thematic analysis was undertaken. Feedback from OPAT patients in our centre was overwhelmingly positive. The key themes identified were benefits to the patients, their friends, and family, and positive feedback about OPAT staff. The mean overall satisfaction score for OPAT was 9.6 out of 10. Areas to improve included communication between the OPAT and parent teams, improving OPAT capacity, and expansion of the service.
Collapse
Affiliation(s)
- Shuchita Soni
- Department of Infectious Diseases, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol BS10 5NB, UK
| | - Irasha Harding
- Department of Microbiology, Bristol Royal Infirmary, Marlborough Street, Bristol BS1 3NU, UK;
| | - Carys Jones
- Department of Pharmacy, Bristol Royal Infirmary, Marlborough Street, Bristol BS1 3NU, UK; (C.J.); (S.W.); (J.N.)
| | - Sue Wade
- Department of Pharmacy, Bristol Royal Infirmary, Marlborough Street, Bristol BS1 3NU, UK; (C.J.); (S.W.); (J.N.)
| | - Jenna Norton
- Department of Pharmacy, Bristol Royal Infirmary, Marlborough Street, Bristol BS1 3NU, UK; (C.J.); (S.W.); (J.N.)
| | - Jennifer Siobhan Pollock
- Sirona Care and Health CIC, Second Floor, Kingswood Civic Centre, High Street, Kingswood, Bristol BS15 9TR, UK;
| |
Collapse
|
8
|
Fernández-Rubio B, Herrera-Hidalgo L, de Alarcón A, Luque-Márquez R, López-Cortés LE, Luque S, Gutiérrez-Urbón JM, Fernández-Polo A, Gutiérrez-Valencia A, Gil-Navarro MV. Stability Studies of Antipseudomonal Beta Lactam Agents for Outpatient Therapy. Pharmaceutics 2023; 15:2705. [PMID: 38140046 PMCID: PMC10747133 DOI: 10.3390/pharmaceutics15122705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) is a useful treatment strategy against Pseudomonas aeruginosa and other multidrug-resistant bacteria. However, it is hindered by the lack of stability data for the administration of antibiotics under OPAT conditions. Our objective was to investigate the stability of nine antipseudomonal and broad-spectrum beta lactam antibiotics (aztreonam, cefepime, cefiderocol, ceftazidime, ceftazidime/avibactam, ceftolozane/tazobactam, meropenem, meropenem/vaborbactam, and piperacillin/tazobactam) to allow the spread of OPAT programs. All the antibiotics were diluted in 500 mL 0.9% sodium chloride and stored at 4, 25, 32, and 37 °C for 72 h in two different devices (infusion bags and elastomeric pumps). The solutions were considered stable if the color, clearness, and pH remained unchanged and if the percentage of intact drug was ≥90%. All the antimicrobials remained stable 72 h under refrigerated conditions and at least 30 h at 25 °C. At 32 °C, all the antibiotics except for meropenem and meropenem/vaborbactam remained stable for 24 h or more. At 37 °C, only aztreonam, piperacillin/tazobactam, cefepime, cefiderocol, and ceftolozane/tazobactam were stable for at least 24 h. The stability results were the same in the two devices tested. All the antibiotics studied are actual alternatives for the treatment of antipseudomonal or multidrug-resistant infections in OPAT programs, although the temperature of the devices is crucial to ensure antibiotic stability.
Collapse
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; (B.F.-R.); (M.V.G.-N.)
| | - Laura Herrera-Hidalgo
- Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain; (B.F.-R.); (M.V.G.-N.)
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Parasitologia, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain; (A.d.A.); (R.L.-M.); (A.G.-V.)
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (L.E.L.-C.); (S.L.)
| | - Arístides de Alarcón
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Parasitologia, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain; (A.d.A.); (R.L.-M.); (A.G.-V.)
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (L.E.L.-C.); (S.L.)
| | - Rafael Luque-Márquez
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Parasitologia, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain; (A.d.A.); (R.L.-M.); (A.G.-V.)
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (L.E.L.-C.); (S.L.)
| | - Luis E. López-Cortés
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (L.E.L.-C.); (S.L.)
- Infectious Diseases and Microbiology Clinical Unit, University Hospital Virgen Macarena/Department of Medicine, School of Medicine, University of Sevilla/Biomedicine Institute of Sevilla (IBiS)/CSIC, 41009 Seville, Spain
| | - Sònia Luque
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (L.E.L.-C.); (S.L.)
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 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, Institut de Recerca Vall d’Hebron, 08035 Barcelona, Spain;
| | - Alicia Gutiérrez-Valencia
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Parasitologia, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain; (A.d.A.); (R.L.-M.); (A.G.-V.)
| | - María V. Gil-Navarro
- Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain; (B.F.-R.); (M.V.G.-N.)
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Parasitologia, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain; (A.d.A.); (R.L.-M.); (A.G.-V.)
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain; (L.E.L.-C.); (S.L.)
| |
Collapse
|
9
|
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.
Collapse
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;
| |
Collapse
|
10
|
Barton A, Fisher E, Rees-Milton M. Elastomeric, fillable infusion pumps: an overview for clinical practice. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:3-7. [PMID: 38530670 DOI: 10.12968/bjon.2023.32.sup15.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Due to advances in elastomeric pump technology, there are now devices available that can be filled with intravenous (IV) therapy at the bed or chair side. These devices are safe, reliable and enable the patient to be mobile when having their infusion. The Surefuser™+ elastomeric infusion pump is available in multiple configurations and allows patients to remain independent and receive IV therapy infusions in their own homes. The pump can also be used in the acute healthcare setting where traditional electronic infusion pumps may not be available. This article provides an overview of the Surefuser+ elastomeric infusion pump, its features and mode of action and how it can be used in clinical practice.
Collapse
Affiliation(s)
- Andrew Barton
- Nurse Consultant, Vascular Access and IV Therapy, Frimley Health NHS Foundation Trust, and Chair, NIVAS
| | - Ed Fisher
- Venous Access Nurse Practitioner, St George's University Hospitals NHS Foundation Trust, London
| | - Martin Rees-Milton
- Principal Pharmacist Technical Services, Velindre Cancer Centre, Cardiff
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
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: 13] [Impact Index Per Article: 13.0] [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.
Collapse
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
| | | | | |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Van Abel AL, Childs-Kean LM, Jensen KL, Mynatt RP, Ryan KL, Rivera CG. A review of evidence, antimicrobial stability, and feasibility considerations for OPAT continuous infusion. Ther Adv Infect Dis 2023; 10:20499361231191877. [PMID: 37636216 PMCID: PMC10451047 DOI: 10.1177/20499361231191877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/18/2023] [Indexed: 08/29/2023] Open
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) has been widely used in clinical practice for many decades because of its associated cost savings, reductions in inpatient hospital days, and decreases in hospital-associated infections. Despite this long history, evolving practice patterns and new drug delivery devices continue to present challenges as well as opportunities for clinicians when designing appropriate outpatient antimicrobial regimens. One such change is the increasing use of extended and continuous infusion (CI) of antimicrobials to optimize the achievement of pharmacokinetic and pharmacodynamic targets. Elastomeric devices are also becoming increasingly popular in OPAT, including for the delivery of CI. In this article, we review the clinical evidence for CI in OPAT, as well as practical considerations of patient preferences, cost, and antimicrobial stability.
Collapse
Affiliation(s)
- Amy L. Van Abel
- Department of Pharmacy, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | | | - Kelsey L. Jensen
- Mayo Clinic Health System – Southeast Minnesota Region, Austin, MN, USA
| | | | - Keenan L. Ryan
- Department of Pharmacy, University of New Mexico, Albuquerque, NM, USA
| | | |
Collapse
|
15
|
Lai T, Thiele H, Rogers BA, Hillock N, Adhikari S, McNamara A, Rawlins M. Exploring the advancements of Australian OPAT. Ther Adv Infect Dis 2023; 10:20499361231199582. [PMID: 37745256 PMCID: PMC10515521 DOI: 10.1177/20499361231199582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) in Australia has evolved from modest beginnings to a well-established health service with proven benefits in patient outcomes. This is a comprehensive review of the current state of art Australian OPAT with vignettes of the types of OPAT models of care, antimicrobial prescribing and antimicrobial use. In addition, we highlight the similarities and differences between OPAT to other countries and describe Australian OPAT experiences with COVID-19 and paediatrics. Australian OPAT continues to advance with OPAT antifungals, novel treatment options and upcoming high-impact research.
Collapse
Affiliation(s)
- Tony Lai
- The University of Sydney School of Pharmacy, Bank Building - The University Of Sydney, 3 Parramatta Rd, Camperdown NSW 2050, Australia
| | - Horst Thiele
- Hospital in the Home, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Benjamin A. Rogers
- Monash University School of Clinical Sciences at Monash Health, Clayton, VIC, Australia
- Hospital in the Home program, Monash Health, Clayton, VIC, Australia
| | - Nadine Hillock
- National Antimicrobial Utilisation Surveillance Program, South Australia Health, Adelaide, SA, Australia
| | - Suman Adhikari
- Department of Pharmacy, St George Hospital, Kogarah, NSW, Australia
- School of Clinical Medicine, The University of New South Wales, Sydney, NSW, Australia
| | | | - Matthew Rawlins
- Department of Pharmacy, Fiona Stanley Hospital, Murdoch, WA, Australia
| |
Collapse
|
16
|
Ortonobes S, Mujal-Martínez A, de Castro Julve M, González-Sánchez A, Jiménez-Pérez R, Hernández-Ávila M, De Alfonso N, Maye-Pérez I, Valle-Delmás T, Rodríguez-Sánchez A, Pino-García J, Gómez-Valent M. Successful Integration of Clinical Pharmacists in an OPAT Program: A Real-Life Multidisciplinary Circuit. Antibiotics (Basel) 2022; 11:1124. [PMID: 36009993 PMCID: PMC9404975 DOI: 10.3390/antibiotics11081124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/08/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) programs encompass a range of healthcare processes aiming to treat infections at home, with the preferential use of the intravenous route. Although several barriers arise during the implementation of OPAT circuits, recent cumulative data have supported the effectiveness of these programs, demonstrating their application in a safe and cost-effective manner. Given that OPAT is evolving towards treating patients with higher complexity, a multidisciplinary team including physicians, pharmacists, and nursing staff should lead the program. The professionals involved require previous experience in infectious diseases treatment as well as in outpatient healthcare and self-administration. As we describe here, clinical pharmacists exert a key role in OPAT multidisciplinary teams. Their intervention is essential to optimize antimicrobial prescriptions through their participation in stewardship programs as well as to closely follow patients from a pharmacotherapeutic perspective. Moreover, pharmacists provide specialized counseling on antimicrobial treatment technical compounding. In fact, OPAT elaboration in sterile environments and pharmacy department clean rooms increases OPAT stability and safety, enhancing the quality of the program. In summary, building multidisciplinary teams with the involvement of clinical pharmacists improves the management of home-treated infections, promoting a safe self-administration and increasing OPAT patients' quality of life.
Collapse
Affiliation(s)
- Sara Ortonobes
- Pharmacy Department, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Barcelona, Spain
- Parc Taulí Research and Innovation Institute Foundation (I3PT), 08028 Sabadell, Barcelona, Spain
| | - Abel Mujal-Martínez
- Parc Taulí Research and Innovation Institute Foundation (I3PT), 08028 Sabadell, Barcelona, Spain
- Hospital at Home Unit, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Barcelona, Spain
| | - María de Castro Julve
- Pharmacy Department, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Barcelona, Spain
- Parc Taulí Research and Innovation Institute Foundation (I3PT), 08028 Sabadell, Barcelona, Spain
| | - Alba González-Sánchez
- Hospital at Home Unit, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Barcelona, Spain
| | - Rafael Jiménez-Pérez
- Hospital at Home Unit, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Barcelona, Spain
| | - Manuel Hernández-Ávila
- Hospital at Home Unit, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Barcelona, Spain
| | - Natalia De Alfonso
- Hospital at Home Unit, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Barcelona, Spain
| | - Ingrid Maye-Pérez
- Hospital at Home Unit, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Barcelona, Spain
| | - Teresa Valle-Delmás
- Hospital at Home Unit, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Barcelona, Spain
| | - Alba Rodríguez-Sánchez
- Hospital at Home Unit, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Barcelona, Spain
| | - Jessica Pino-García
- Pharmacy Department, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Barcelona, Spain
| | - Mònica Gómez-Valent
- Pharmacy Department, Consorci Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Barcelona, Spain
- Parc Taulí Research and Innovation Institute Foundation (I3PT), 08028 Sabadell, Barcelona, Spain
| |
Collapse
|
17
|
Prepared omadacycline for injection: Nine-day stability and sterility in an elastomeric pump. SAGE Open Med 2022; 10:20503121221135568. [DOI: 10.1177/20503121221135568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022] Open
Abstract
Objective: To investigate compatibility, stability, and microbiologic risk of omadacycline 1 mg/mL when prepared in an elastomeric infusion pump and stored under refrigeration for 9 days based upon requests for information from healthcare providers. Methods: Omadacycline was reconstituted to 1 mg/mL with sodium chloride 0.9% w/v or dextrose 5% w/v in SMARTeZ® elastomeric infusion pumps and refrigerated for up to 9 days. Samples were taken daily and tested for appearance, pH, osmolality, chemical composition, and particulate matter. For a microbial challenge study, the pumps were spiked with a challenge microorganism ( Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Candida albicans, or Aspergillus brasiliensis) and samples were plated daily for 9 days to assess microbial survival. Results: Appearance, pH, osmolality, percent label claim, and particulate matter results remained essentially unchanged for omadacycline solutions in either diluent over the 9-day study. No > 0.5-log day-to-day increases in the challenge-microorganism populations were measured in diluted omadacycline pumps or positive controls. With omadacycline, no growth was seen for S. aureus or E. coli in either diluent, nor for P. aeruginosa in dextrose 5% w/v. Reduction of C. albicans and A. brasiliensis populations over time was similar between omadacycline solutions and positive controls. Conclusion: After reconstitution, omadacycline for injection was stable and remained within specifications for use for up to 9 days when refrigerated.
Collapse
|