Recent innovations and new applications of outpatient parenteral antimicrobial therapy

Farmer, Eoghan C. W.; Seaton, R Andrew

doi:10.1080/14787210.2020.1810566

Cited by 13 publications

(8 citation statements)

References 58 publications

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“…New trends in OPAT are pointing towards reducing the consumption of health care resources [ 32 , 34 ]. Several strategies have been proposed in this scenario, such as the OPAT self-administration modality (S-OPAT) or treatment with long-acting agents.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of an Innovative Cefazolin Delivery Program for MSSA Infections in OPAT

Herrera‐Hidalgo

Luque‐Márquez

Alarcón

et al. 2022

JCM

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Cefazolin is a recommended treatment for methicillin-susceptible Staphylococcus aureus (MSSA) infections that has been successfully used in outpatient parenteral antibiotic therapy (OPAT) programs. The aim of this study was to assess the clinical outcomes of cefazolin delivered each day (Group 24) vs. every two days (Group 48) for MSSA infections in OPAT programs. It was a prospective observational study with retrospective analysis of a cohort of MSSA infections attended in OPAT. The primary outcome was treatment success, defined as completing the antimicrobial regimen without death, treatment discontinuation, or readmission during treatment and follow-up. A univariate and multivariate logistic regression model was built. A two-sided p < 0.05 was considered statistically significant. Of the 149 MSSA infections treated with cefazolin 2 g/8 h in OPATs, 94 and 55 patients were included in the delivery Group 24 and Group 48, respectively. Treatment failure and unplanned readmission rates were similar in both groups (11.7% vs. 7.3% p = 0.752 and 8.5% vs. 5.5% p = 0.491). There was a significant increase in vascular access complications in Group 24 (33.0%) with respect to Group 48 (7.3%) (p < 0.001). Treating uncomplicated MSSA infection with cefazolin home-delivered every two days through an OPAT program is not associated with an increased risk of treatment failure and entails a significant reduction in resource consumption compared to daily delivery.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of an Innovative Cefazolin Delivery Program for MSSA Infections in OPAT

Herrera‐Hidalgo

Luque‐Márquez

Alarcón

et al. 2022

JCM

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“…It is usually believed that OPAT can lengthen intravenous therapy, especially in antimicrobial treatment. In this sense, another important aspect of ASP in OPAT programs is to facilitate an intravenous-to-oral switch as soon as allowed by a clinical evolution of the infection and whenever an oral therapeutic alternative is possible [ 80 ]. For example, Dryden et al reported that an ASP team (including the same professional profiles as our OPAT team) has a significant positive impact on the optimal use of antibiotics, such as increasing the switch from intravenous to oral treatment.…”

Section: Implementation Of An Opat Multidisciplinary Circuitmentioning

confidence: 99%

Successful Integration of Clinical Pharmacists in an OPAT Program: A Real-Life Multidisciplinary Circuit

et al. 2022

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Outpatient parenteral antimicrobial therapy (OPAT) programs encompass a range of healthcare processes aiming to treat infections at home, with the preferential use of the intravenous route. Although several barriers arise during the implementation of OPAT circuits, recent cumulative data have supported the effectiveness of these programs, demonstrating their application in a safe and cost-effective manner. Given that OPAT is evolving towards treating patients with higher complexity, a multidisciplinary team including physicians, pharmacists, and nursing staff should lead the program. The professionals involved require previous experience in infectious diseases treatment as well as in outpatient healthcare and self-administration. As we describe here, clinical pharmacists exert a key role in OPAT multidisciplinary teams. Their intervention is essential to optimize antimicrobial prescriptions through their participation in stewardship programs as well as to closely follow patients from a pharmacotherapeutic perspective. Moreover, pharmacists provide specialized counseling on antimicrobial treatment technical compounding. In fact, OPAT elaboration in sterile environments and pharmacy department clean rooms increases OPAT stability and safety, enhancing the quality of the program. In summary, building multidisciplinary teams with the involvement of clinical pharmacists improves the management of home-treated infections, promoting a safe self-administration and increasing OPAT patients’ quality of life.

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“…Antibiotics 2021, 10, x FOR PEER REVIEW 2 of 12 without hospitalization, is also becoming increasingly popular in clinical practice [10]. However, continuous infusion of meropenem has been limited owing to concerns with instability, including prolonged storage time before administration.…”

Section: Infusate Stability At Room Temperaturementioning

confidence: 99%

“…In order to maximize antimicrobial target attainment and clinical cure in severe illness, meropenem is typically administered with continuous infusion regimens after application of a loading dose [7][8][9]. The administration of meropenem in outpatient parenteral antimicrobial therapy (OPAT), representing the administration of IV antibiotics without hospitalization, is also becoming increasingly popular in clinical practice [10].…”

Section: Introductionmentioning

confidence: 99%

The Role of Non-Enzymatic Degradation of Meropenem—Insights from the Bottle to the Body

et al. 2021

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Several studies have addressed the poor stability of meropenem in aqueous solutions, though not considering the main degradation product, the open-ring metabolite (ORM) form. In the present work, we elucidate the metabolic fate of meropenem and ORM from continuous infusion to the human bloodstream. We performed in vitro infusate stability tests at ambient temperature with 2% meropenem reconstituted in 0.9% normal saline, and body temperature warmed buffered human serum with 2, 10, and 50 mg/L meropenem, covering the therapeutic range. We also examined meropenem and ORM levels over several days in six critically ill patients receiving continuous infusions. Meropenem exhibited a constant degradation rate of 0.006/h and 0.025/h in normal saline at 22 °C and serum at 37 °C, respectively. Given that 2% meropenem remains stable for 17.5 h in normal saline (≥90% of the initial concentration), we recommend replacement of the infusate every 12 h. Our patients showed inter-individually highly variable, but intra-individually constant molar ORM/(meropenem + ORM) ratios of 0.21–0.52. Applying a population pharmacokinetic approach using the degradation rate in serum, spontaneous degradation accounted for only 6% of the total clearance.

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Recent innovations and new applications of outpatient parenteral antimicrobial therapy

Cited by 13 publications

References 58 publications

Clinical Outcomes of an Innovative Cefazolin Delivery Program for MSSA Infections in OPAT

Clinical Outcomes of an Innovative Cefazolin Delivery Program for MSSA Infections in OPAT

Successful Integration of Clinical Pharmacists in an OPAT Program: A Real-Life Multidisciplinary Circuit

The Role of Non-Enzymatic Degradation of Meropenem—Insights from the Bottle to the Body

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