Clinical Effectiveness of Continuous Infusion Flucloxacillin in the Outpatient Parenteral Antimicrobial Therapy (OPAT) Setting in a UK Hospital: A Service Evaluation

Abstract

The availability of stability data for the use of continuous intravenous flucloxacillin in an elastomeric device has enabled the treatment of serious Methicillin Sensitive Staphylococcus aureus (MSSA) in the outpatient parenteral antimicrobial therapy (OPAT) setting. This service review aimed to evaluate current standard of care to establish the clinical effectiveness and complication rates associated with its use since its introduction at our institution. A retrospective review of clinical outcomes and adverse events/complications, was undertaken for all patients who received continuous infusion flucloxacillin for complicated MSSA infection between January 2019 and July 2022 via our OPAT service. Thirty-nine patients were included. An OPAT treatment outcome of ‘Treatment aim attained uncomplicated’ was achieved in 29/39 (74%) patients. Two patients had an OPAT treatment outcome of treatment aim not attained, both of which required unexpected hospital re-admission. An adverse event/complication occurred in 8 patients. There were two relapses in the 12-month follow-up period. Our review supports the assertion that continuous infusion flucloxacillin is clinically effective and well tolerated for the treatment of complicated MSSA infection in the OPAT setting.

Clinical, organizational, and pharmacoeconomic perspectives of dalbavancin vs standard of care in the infectious disease network

“…The possibility of continuing complex antibiotic therapy in the outpatient setting or at home has been favored by pharmacodynamics (PD) and pharmacokinetics (PK) studies that have redefined the methods of administering antibiotics by continuous infusion (CI) over 24 hours rather than intermittent or extended infusion administration, maximizing microbiological and clinical outcome. Several clinical studies showed that attaining an aggressive PK/PD target of 100% fT >4-8 × minimum inhibitory concentration (MIC) with CI beta-lactams among critically ill patients was associated with both the maximization of clinical efficacy and the suppression of resistance development ( 4 , 5 ).…”