Outpatient Parenteral Antibiotic Therapy in the Elderly: an Italian Observational Multicenter Study

Abstract

Bacterial infections are the most frequent cause of hospitalization in elderly patients. In the early eighties, the advantages of Outpatient parenteral Antibiotic therapy (OPAT) were identified in the United States, and suitable therapeutic programs were established. In order to understand the different ways of managing OPAT, a National OPAT Registry was set up in 2003 in Italy. This study analyzes data concerning bacterial infections in 176 elderly patients including demographics, therapeutic management, clinical response, and side-effects. Bone and joint infections (48.9%) and skin and soft tissue infections (27.8%) were the most common infections treated with OPAT. Teicoplanin (28.9%) and ceftriaxone (22.1%) were the top two antibiotics chosen. OPAT was mainly performed at a hospital infusion center (52.8%). The clinical success rate was high and side-effects were low (12.6% of cases). Management of bacterial infections in the elderly with an outpatient program is effective and safe.

Safety and effectiveness of ‘hospital in the home’ and ‘outpatient parenteral antimicrobial therapy’ in different age groups: A systematic review of observational studies

“…There are different models of OPAT services which include self‐administration, infusion in an outpatient setting or clinician assisted antibiotic therapy . OPAT outcome registries for storage of all data relating to the OPAT service to monitor practice are now in use in some countries including the USA, Italy and Spain . In addition, the International OPAT registry has been initiated which contains data from the USA, the UK, Canada and Italy .…”

“…Numerous studies assessing the adverse events (AEs) and effectiveness of HITH and OPAT have been performed in many countries including Australia, USA, UK, Spain, France, Singapore, Israel, Canada, Italy, Ireland, New Zealand, Saudi Arabia, Switzerland and Greece . Some studies have analysed the safety of HITH or OPAT for a particular disease or for a particular group including geriatric or paediatric patients …”

“…Older people who commonly have comorbid conditions are at a higher risk when admitted to HITH or OPAT . Children present different challenges to adults when cared for in the home and separate guidelines have been formed for paediatric OPAT services .…”

“…Numerous studies assessing the adverse events (AEs) and effectiveness of HITH and OPAT have been performed in many countries including Australia, 2,9,[19][20][21][22][23][24][25][26] USA, [27][28][29][30][31][32][33][34][35][36][37][38][39][40] UK, 4,[41][42][43][44][45] Spain, 3,8,11,15,46 France, 47,48 Singapore, 12,49 Israel, 50 Canada, 51 Italy, 17 Ireland, 52 New Zealand, 53 Saudi Arabia, 54 Switzerland 55 and Greece. 56 Some studies have analysed the safety of HITH or OPAT for a particular disease or for a particular group including geriatric 11,15,17,…”

Treatment Options for Gram-Positive and Gram-Negative Bacteria: Focus on Ceftriaxone

“…Accordingly, ceftriaxone is widely used for home intravenous antibiotics therapy (HIAT) 151 or for 33%-42% of cases treated with outpatient parenteral antimicrobial therapy (OPAT) in the USA, [152][153][154] 14.7% of the cases treated in another study, 155 and 22.1% of elderly patients treated in Italy. 156 Two ceftriaxone delivery models are commonly used: i) an outpatient or infusion center, or OPAT model; and ii) a visiting nurse or self-administration model, or HIAT model. The basic premise for performing such treatments is to ensure the stability of patients or to alleviate the burden of social problems, such as end-stage cancer.…”