Monitoring of Outpatient Parenteral Antimicrobial Therapy and Implementation of Clinical Pharmacy Services at a Community Hospital Infusion Unit

Shah, Punit J.; Bergman, Scott; Graham, Donald R.; Glenn, Stephanie

doi:10.1177/0897190014544786

Cited by 24 publications

(22 citation statements)

References 19 publications

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“…Methicillin-sensitive S. aureus was the most frequent involved pathogen in this study and consequently flucloxacillin sodium was the most frequent used antibiotic. As there were no cases with MRSA in our study, this is different to other studies with vancomycin being used more often [2, 5, 19, 20]. Endocarditis appeared to be underrepresented in this study with only 3.3% of the cases reflecting the policy of our department of cardiology at that time with strong preference to treat patients with infective endocarditis in the hospital.…”

Section: Discussioncontrasting

confidence: 83%

“…A formal ID consultation was performed in 39% of the cases. Previously, an ID consult was shown to result in a more safe and effective OPAT, with less incorrect use of intravenous antibiotic therapy and thus saving costs [8, 11, 12, 19]. Furthermore, an ID consult might prevent OPAT in 10% of all requests without any impact on the patient’s clinical outcome [13].…”

Section: Discussionmentioning

confidence: 99%

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The impact of an infectious disease expert team on outpatient parenteral antimicrobial treatment in the Netherlands

et al. 2018

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Background There is increasing interest in outpatient parenteral antimicrobial treatment. Objective To evaluate the added value of consultation of an infectious diseases expert team (consisting of two internist-infectious diseases specialists and a microbiologist) for advice regarding type, administration route and duration of antibiotic treatment. Setting A retrospective case series was performed at the Haga Teaching Hospital, a 700-bed regional teaching hospital in The Hague, The Netherlands. Methods Complication rate and mortality was evaluated during 60 days of follow-up. Therapeutic rationality regarding outpatient parenteral antimicrobial treatment was determined by presenting randomly selected paper cases from the database to two independent infectious diseases specialists who were blinded to patient’s treatment and outcomes. The concordance between the two advices were analysed using Cohen’s kappa. For those with discordance, an infectious diseases expert team meeting was organized to reach consensus. The final recommendation was compared to the actual given antibiotic treatment. Main outcome measure Discrepancy between the infectious disease expert team recommendations upon type, administration route and duration of antibiotics and the real outpatient parenteral antimicrobial treatment practice. Results Out of 89 included cases, 50 were randomly selected for review by the infectious diseases specialists. The kappa statistic regarding antimicrobial policy was 0.581 ( P < 0.001). In 78% (39/50 cases), they had complete agreement upon all aspects of antibiotic treatment. The remaining 11 cases were reviewed by the expert team. Comparing the consensus of 50 cases to actual practice, in 14(28%) cases there was a discrepancy suggesting potential room for improvement. Comparing the cases in whom an individual infectious diseases specialist was involved in real practice to those cases without, there was 18% versus 42% discrepancy with the recommendations of the expert team (OR 3.4; 95% CI: 0.9–12.5, P = 0.06). Complication rate was 19% including unplanned readmissions and side effects of antimicrobial agent or administration route. Conclusion Though outpatient parenteral antimicrobial treatment policies in the Netherlands appear to be safe, consultation of an ID expert team, rather than an individual ID specialist, has the potential to optimize antimicrobial treatment in patients considered suitable for outpatient parenteral antimicrobial treatment. Electronic supplementary material The online version of this article (10.1007/s11096-018-0751-4) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

The impact of an infectious disease expert team on outpatient parenteral antimicrobial treatment in the Netherlands

et al. 2018

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“…5 Pharmacists have also been shown to improve compliance with OPAT monitoring guidelines, resulting in up to 100% compliance in 1 study. 6 Another study found that the involvement of pharmacists in OPAT monitoring ensured minimal out-of-range vancomycin troughs, with only 12 of the 458 obtained being considered subtherapeutic or supratherapeutic. 18 Based on the available literature, there is certainly a role for a pharmacist in improving patient-oriented outcomes during prolonged outpatient antimicrobial therapy.…”

Section: Discussionmentioning

confidence: 99%

Characterization of Drug-Related Problems Occurring in Patients Receiving Outpatient Antimicrobial Therapy

Hale

Steele

Seabury

et al. 2017

Journal of Pharmacy Practice

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“…Example of a new approach could be the hiring of an infectious diseases pharmacist. This approach has been used in many countries in different settings relating to the rational use of antimicrobials and the impact has been good [ 20 , 21 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Antimicrobial Therapy of Blood Culture Positive Healthcare-Associated Infections in Children

et al. 2015

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AimKnowledge of the quality of antimicrobial therapy (AMT) used for invasive healthcare-associated infections (HAIs) in paediatrics is scarce. Influence of the final information about the isolated pathogen on the subsequent targeted AMT was investigated in our study.MethodsData on 149 children (0–17 years) with blood culture positive HAIs were collected. The causative microbes under investigation were Staphylococcus aureus, Staphylococcus epidermidis, streptococci, Gram negative rods, and mixed infections were likewise included. For adjusting the antimicrobial regimen, an expert panel evaluated the quality of the targeted AMT and the delay of 72 hours after final microbiology results. AMT was regarded as inappropriate if the pathogen was totally resistant to the used antimicrobials (i) or if the chosen therapy was of not optimal efficacy against the pathogen (ii).Results17% of the patients received inappropriate AMT. Half of these infections 13/26 (50%) were treated with an antimicrobial to which the isolate was resistant. Three (3/13, 23%) of these patients received antimicrobials which were totally ineffective according to in vitro data. Suboptimal or too broad spectrum AMT was administered to 13/26 (50%) patients. The most common causes of inappropriate use were the use of beta-lactams in oxacillin-resistant Staphylococcus epidermidis infections and vancomycin given in oxacillin-sensitive Staphylococcus aureus infections.ConclusionApproximately 17% of the selected cohort received inappropriate AMT. More attention should be paid to the appropriate use of antimicrobials, and training of prescribers should be urgently provided.

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Monitoring of Outpatient Parenteral Antimicrobial Therapy and Implementation of Clinical Pharmacy Services at a Community Hospital Infusion Unit

Cited by 24 publications

References 19 publications

The impact of an infectious disease expert team on outpatient parenteral antimicrobial treatment in the Netherlands

The impact of an infectious disease expert team on outpatient parenteral antimicrobial treatment in the Netherlands

Characterization of Drug-Related Problems Occurring in Patients Receiving Outpatient Antimicrobial Therapy

Evaluation of Antimicrobial Therapy of Blood Culture Positive Healthcare-Associated Infections in Children

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