Outpatient Parenteral Antimicrobial Therapy Today

Abstract

Since its introduction in the 1970s, outpatient parenteral antimicrobial therapy (OPAT) has become a standard modality for patients with many infections requiring long-term intravenous antibiotic therapy. Delivery of OPAT may occur in physicians' offices, hospital clinics, specialized infusion centers, and currently most often, patient's homes, often self-administered. Patients are selected for OPAT by physicians familiar with both the course of their infections, their personal suitability for outpatient care, and the availability of reimbursement. OPAT is reportedly safe, effective, practical, and cost-effective. An OPAT Outcomes Registry contains information from >11,000 antibiotic courses administered from 1997 through 2000. Although a number of studies are purported to analyze the economic impact of OPAT on health care, a comprehensive, clinical outcomes-based pharmacoeconomic analysis, as described here, has, to our knowledge, yet to be done.

The Community IntraVenous Antibiotic Study (CIVAS): a mixed-methods evaluation of patient preferences for and cost-effectiveness of different service models for delivering outpatient parenteral antimicrobial therapy

“…A comprehensive pharmacoeconomic evaluation of OPAT services has yet to be completed, despite the number of published studies. 1 Chapman et al 13 did complete a cost-effectiveness analysis of OPAT in a UK setting but this included only one centre and was predominantly a comparison of standard hospital inpatient care with daily attendance at a hospital facility. In addition, owing to a lack of appropriate data, the analysis completed was a cost-consequence analysis rather than a cost-utility analysis and, thus, did not adhere to National Institute for Health and Care Excellence (NICE) guidance.…”

“…Service models 1. A wide range of infections were treated, from cellulitis to bone and joint infections, diabetic foot infections, respiratory, renal and other infections in a broad range of specialties.…”

“…93 In contrast, OPAT has been accepted as the standard of care in the USA and Australia for many years, although it has been restricted to those with appropriate insurance. 1 The 2013 BSAC survey of OPAT in the UK 94 found that 68% of centres have some form of OPAT service (based on a 63% response rate to an electronic survey). The most commonly reported model of care was a nurse at home, followed by a hospital attendance, but other models are used.…”

“…difficile diarrhoea (1) Access-related complications were: line infection (3), leaking line (3), mechanical phlebitis (2) and thrombosis (6) Mazo et al…”

Hospitalist Perspective on the Treatment of Skin and Soft Tissue Infections

“…Those who are afebrile with stabilized vital signs, comorbidities, and nonprogressive infection and who require daily IV therapy but do not need 24-hour acute care nursing are candidates for outpatient parenteral antimicrobial therapy. 103,104 Outpatient parenteral antimicrobial therapy is an important consideration for patients because it can improve patients' quality of life, reduce readmission, decrease risk of nosocomial complications, reduce costs, and help patients transition to care outside the hospital. 104,105 Once a patient is admitted, hospitalists play a key role in optimizing length of stay by determining appropriate antimicrobial regimens and evaluating the need for surgical intervention.…”