Quality-of-Life Assessment in an Outpatient Parenteral Antibiotic Program

Goodfellow, Alan F; Wai, Amy O; Frighetto, Luciana; Marra, Carlo; Ferreira, Barbara M; Chase, Margaret; Nicol, Ruth E; Leong, Carole A; Tomlinson, Sally; Jewesson, Peter J.

doi:10.1345/1542-6270(2002)036<1851:qolaia>2.0.co;2

Cited by 4 publications

(5 citation statements)

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“…Compared with hospital admission, there are a number of potential benefits for the patient of being at home, including improved psychological outcomes, less disruption to family life and reduced hospital-acquired infections1 2 There are also benefits to the healthcare system, including improved patient flow and greater cost-effectiveness for the same management 3. With changing models of care and greater financial pressure on hospitals, the impetus for home-based care is likely to increase.…”

Section: Introductionmentioning

confidence: 99%

“…In adults, studies show equivalent outcomes to inpatient care, reduced re-presentation rates and higher patient and carer satisfaction rates 3–5. OPAT is one of the interventions that can be delivered by an HITH programme, and in adults it has been shown to improve physical, social and emotional quality-of-life parameters compared with hospital-based treatment 3. However, there are potential risks such as adverse events at home and suboptimal decision-making regarding antibiotics.…”

Section: Introductionmentioning

confidence: 99%

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The use, appropriateness and outcomes of outpatient parenteral antimicrobial therapy

et al. 2016

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Objective Outpatient parenteral antimicrobial therapy (OPAT) is increasingly used to treat children at home, but studies in children are scarce. We aimed to describe the use, appropriateness and outcomes of OPAT in children. Design This was a 12-month prospective observational study. Setting The hospital-in-the-home programme of The Royal Children's Hospital Melbourne. Patients All patients receiving OPAT. Interventions Data were collected including demographics, diagnosis, type of venous access and antibiotic choice. Main outcome measures Length of stay, adverse events, readmission rate and appropriateness of antibiotic use. Results 228 patients received OPAT in 251 episodes. The median age was 7.4 years (range 1 week to 21 years), with 22 patients (10%) under 1 year. The most frequent diagnoses were exacerbation of cystic fibrosis (17%), urinary tract infection (12%) and cellulitis (9%). Most patients were transferred from the ward, but 18% were transferred directly from the emergency department, the majority with skin and soft-tissue infection (66%). Venous access was most commonly peripherally inserted central catheter (29%) and peripheral cannula (29%). 309 parenteral antibiotics were prescribed, most frequently ceftriaxone (28%) and gentamicin (19%). The majority of antibiotics (72%) were prescribed appropriately. However, 6% were deemed an inappropriate choice for the indication and 26% had inappropriate dose or duration. The incidence of central line-associated bloodstream infections was 0.9%. The unplanned readmission rate was 4%, with low rates of OPAT-related adverse events. Three children (1%) had an inadequate clinical response. Conclusions OPAT is a safe and effective way of providing antibiotics to children. Despite high rates of appropriate antibiotic use, improvements can still be made. BACKGROUND

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The use, appropriateness and outcomes of outpatient parenteral antimicrobial therapy

et al. 2016

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“…[6][7][8][9][10] With appropriate patient selection, it has been shown to be safe, efficacious, and cost-effective. [9][10][11][12][13][14] The ability to manage patients in the community setting provides the freedom for patients to return to work or educational facilities, reduces pressure on hospital bed utilization, and reduces the risk of developing nosocomial infections. [9][10][11][12][13] There are various models of care for OPAT, which include hospital-based infusion centres, nursing outreach services to patient homes for the administration of antibiotics, and administration by self or family members.…”

Section: Introductionmentioning

confidence: 99%

Supervised self-administration of outpatient parenteral antibiotic therapy: a report from a large tertiary hospital in Australia

Subedi

Looke

McDougall

et al. 2015

International Journal of Infectious Diseases

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There were 150 episodes involving 144 patients resulting in 3520 days of OPAT; the median duration on the programme was 22 days (range 4–106 days). Patient or carer administration occurred in the majority of episodes. The most common indication by far was bone or joint infection (47% of patients), followed by infective endocarditis (9%). Staphylococcus aureus was the most frequently treated organism. The overall cure rate was 93%. On multivariate analysis, patients with two or more comorbidities had an increased risk of failure. Line-related complications occurred in 1.4/1000 catheter-days. Rash was the most common drug-related event. Despite the extensive use of broad-spectrum antibiotics there were no cases of Clostridium difficile infection during therapy and for up to 28 days post cessation of intravenous antibiotics. The cost of OPAT per patient excluding drug administration and home visits was approximately A$ 150.00/day, significantly lower than the cost of an inpatient bed, which is estimated to be A$ 500–800/day.5 CONCLUSION: OPAT using a patient or carer administration model is an effective and safe option for the management of selected patients with infection requiring intravenous antibiotics.

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“…Studies conducted in Australia and USA estimated that the annual cost savings associated with the use of elastomeric intravenous pumps can be up to US$500 000 18 19. Furthermore, a prospective study found that patients had improved physical, mental and emotional experience when they were transferred from the hospital-based treatment to home-based treatment 20. Ceftaroline is effective in the treatment of infections caused by MDR Gram-positive bacteria 11.…”

Section: Discussionmentioning

confidence: 99%

Physical and chemical stability of ceftaroline in an elastomeric infusion device

et al. 2017

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BackgroundSevere infections such as endocarditis and osteomyelitis require long-term treatment with parenteral antibiotics and hence prolonged hospitalisation. Continuous infusion of ceftaroline through elastomeric devices can facilitate early hospital discharge by managing parenteral antibiotics in patient’s home. Therefore, the purpose of this study was to investigate the stability of ceftaroline in a commonly used elastomeric device.MethodA total of 24 elastomeric devices were prepared, and six elastomeric devices containing 6mg/mL of ceftaroline (three in each type of diluents) were stored at one of the following conditions: 4°C for 6 days, 25°C for 24hours, 30°C for 24hours or 35°C for 24hours. An aliquot was withdrawn before storage and at different time points. Chemical stability was measured using a stability indicating high-performance liquid chromatography, and physical stability was assessed as change in pH, colour and particle content.ResultsCeftaroline, when admixed with both diluents, was stable for 144, 24 and 12hours at 4°C, 25°C and 30°C, respectively. At 35°C, ceftaroline admixed with normal saline (NS) and glucose 5% was stable for 12hours and for 6hours, respectively. No evidence of particle formation, colour change or pH change was observed throughout the study period.ConclusionsOur findings support 12 or 24hours continuous elastomeric infusion of ceftaroline-NS admixture, and bulk preparation of elastomeric pumps containing ceftaroline solution in advance. This would facilitate early hospital discharge of patients eligible for the elastomeric-based home therapy and avoid the need for patient’s caregivers travelling to the hospital on a daily basis.

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Quality-of-Life Assessment in an Outpatient Parenteral Antibiotic Program

Cited by 4 publications

References 0 publications

The use, appropriateness and outcomes of outpatient parenteral antimicrobial therapy

The use, appropriateness and outcomes of outpatient parenteral antimicrobial therapy

Supervised self-administration of outpatient parenteral antibiotic therapy: a report from a large tertiary hospital in Australia

Physical and chemical stability of ceftaroline in an elastomeric infusion device

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