Safety and effectiveness of home intravenous antibiotic therapy for multidrug-resistant bacterial infections

Abstract

Home intravenous antibiotic therapy is an alternative to hospital admission for moderately severe infections. However, few studies have analyzed its safety and effectiveness in the treatment of infections caused by multidrug-resistant bacteria. The purpose of this study is to analyze the safety and effectiveness of home intravenous antibiotic therapy in multidrug-resistant bacterial infections. We analyzed prospectively all patients admitted to our service who underwent home intravenous antibiotic therapy during the period 2008-2012. All the treatments were administered by caretakers or self-administered by patients, through elastomeric infusion devices. Effectiveness was evaluated by analyzing the readmission rate for poor infection control. Safety was evaluated by analyzing adverse events, catheter-related complications, and readmissions not related to poor infection control. There were 433 admissions (in 355 patients) for home intravenous antibiotic therapy during the study period. There were 226 (52.2 %) admissions due to multidrug-resistant bacterial infections and 207 (47.8 %) due to non-multidrug-resistant infections. Hospital readmissions in patients with multidrug-resistant infections were uncommon. Multidrug-resistant enterococcal infections, healthcare-associated infections, and carbapenem therapy were independent variables associated with increased readmissions due to poor infection control. Readmissions not related to poor infection control, adverse events, and catheter-related complications were similar in multidrug-resistant compared to non-multidrug-resistant bacterial infections. Home intravenous therapy, administered by patients or their caretakers using elastomeric infusion pumps, was safe and effective for the treatment of most multidrug-resistant bacterial infections.

Implementation of a virtual and in-person hybrid hospital-at-home model in two geographically separate regions utilizing a single command center: a descriptive cohort study

“…With our hospital at home model, we were able to go beyond typical diagnoses seen in home hospital models [11][12][13][14][15] and treat increasingly acute patients in their homes, such as bone marrow transplant patients on day-1 following transplant. These patients, who typically spend 14 or more days in the physical hospital, were able to recover primarily at home while receiving inpatient services.…”

“…The dates were selected to offer the largest data set available at the time of writing and to include both patients treated in ACH prior to the program's participation in the Acute Hospital Care at Home waiver program, which occurred on December 4, 2020, and December 8, 2020, for Mayo Clinic in Florida and Mayo Clinic Health Systems Eau Claire, respectively, and those treated after the beginning of the waiver program. The inclusion criteria for this study were the following: 1) all patients admitted to the ACH program in Florida and Wisconsin with no age restrictions and 2) a medical diagnosis successfully treated in previous hospital at home models (decompensated heart failure, chronic obstructive pulmonary disease exacerbation, and urinary tract infection) [11][12][13][14][15] as well as any general medical or postsurgical condition our medical providers believed that we could safely treat in the home setting. Admission to the ACH program is completely voluntary.…”

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“…In fact, this evolutionary process, which involves the introduction of new genotypes into populations where others were previously circulating and the extinction of the latter [40], is very similar to the seasonal ymerase-RNA-dependent complex. The polymerase then starts transcribing viral mRNAs and replicating the genome, generating positive polarity RNA sequences (antigenome) that serve as a template for the synthesis of negative polarity RNA that will be part of the viral offspring [54]. The "de novo" synthesized genomes bind to the structural proteins that comprise the polymerase-RNA-dependent complex and the N protein to form new nucleocapsids, which are then transported to the infected cell's plasma membrane to bind to the rest of the structural proteins and produce the new virions that are released from the infected cell.…”

Economic burden of skin and skin structure infections due to Gram-positive bacteria in patients on hospital at home-based outpatient parenteral antibiotic therapy (OPAT)

“…OPAT programs have proven to be an effective and safe alternative to hospitalisation in the treatment of complex infections [ 12 ]. HaH has been increasingly used in Spain in recent years [ 13 – 15 ].…”