Self-administered outpatient parenteral antimicrobial therapy (S-OPAT) for infective endocarditis: A safe and effective model

Pajarón, Marcos; Fernández-Miera, Manuel Francisco; Allende, I; Arnáiz, Ana; Gutiérrez‐Cuadra, Manuel; Cobo-Belaustegui, Manuel; Armiñanzas, Carlos; Berrazueta, José R.; Fariñas, María Carmen; Sanroma, Pedro

doi:10.1016/j.ejim.2015.01.001

Cited by 27 publications

(19 citation statements)

References 33 publications

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“…Cure was achieved in 94% of patients, which is in line with the results from other published cohorts. In addition, the re-admission rate of 12% is comparable to what has already been described and only 9 of those were related to OPAT care [2,18,22,23]. These figures are reassuring, considering that a relatively large proportion of the patients have been self-administering their treatment with elastomeric pumps.…”

Section: Discussionsupporting

confidence: 71%

Setting up an outpatient parenteral antimicrobial therapy (OPAT) unit in Switzerland: review of the first 18 months of activity

Gardiol

Voumard

Cochet³

et al. 2016

Eur J Clin Microbiol Infect Dis

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Outpatient parenteral antimicrobial therapy (OPAT) has been recognised as a useful, cost-effective and safe alternative to inpatient treatment, but no formal OPAT unit existed in Switzerland until recently. In December 2013 an OPAT unit was established at Lausanne University Hospital. We review here the experience of this new OPAT unit after 18 months of activity. Patient characteristics, clinical activities and outcomes were recorded prospectively. Need and acceptance was evaluated as number of OPAT courses administered and number of patients refusing OPAT. Safety and efficacy were evaluated as: (1) adverse events linked to antimicrobials and catheters, (2) re-admission to hospital, (3) rate of treatment failures and (4) mortality. Over 18 months, 179 courses of OPAT were administered. Acceptance was high with only four patients refusing OPAT. Urinary tract infections with resistant bacteria and musculoskeletal infections were the most common diagnoses. Self-administration of antibiotics using elastomeric pumps became rapidly the most frequently used approach. Sixteen patients presented with adverse events linked to antimicrobials and catheters. OPAT-related readmissions occurred in nine patients. The overall cure rate was 94 %. This study shows that OPAT is very well accepted by patients and medical staff, even in a setting which has not used this type of treatment approach until now. Self-administration using elastomeric pumps proved to be particularly useful, safe and efficient. OPAT offers a good alternative to hospitalisation for patients presenting with infections due to resistant bacteria that cannot be treated orally anymore and for difficult to treat infections.

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Section: Discussionsupporting

confidence: 71%

Setting up an outpatient parenteral antimicrobial therapy (OPAT) unit in Switzerland: review of the first 18 months of activity

Gardiol

Voumard

Cochet³

et al. 2016

Eur J Clin Microbiol Infect Dis

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“…This study also adds to the growing evidence that self/carer administration of IV antimicrobial therapy is safe [18,23,24]. Comparing the total costs of the OPAT service with estimated costs of equivalent inpatient care, we found that the service has delivered substantial cost savings over its 10 years of operation.…”

Section: Discussionmentioning

confidence: 63%

Clinical efficacy, cost analysis and patient acceptability of outpatient parenteral antibiotic therapy (OPAT): a decade of Sheffield (UK) OPAT service

Durojaiye

Bell

Andrews

et al. 2018

International Journal of Antimicrobial Agents

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Outpatient parenteral antimicrobial therapy (OPAT) has evolved relatively slowly in the UK. This study describes the OPAT service based in a large UK teaching hospital in Sheffield, and examines the clinical efficacy, patient acceptability and costs saved over a 10-year period. Data on 3812 episodes of OPAT administered between January 2006 and January 2016 were retrieved from a prospectively maintained electronic database. This study compared the real costs of the OPAT service with estimated costs of conventional inpatient care for these patient episodes, and analysed patient feedback questionnaires that were administered randomly between January 2014 and January 2015. A wide range of infections were managed during the 10-year period. Skin and soft tissue infections accounted for 57% of OPAT episodes. The total number of bed-days saved was 49,854. A successful outcome (cure or improvement) was found in 3357 (88%) episodes. Re-admission occurred in 265 (7%) episodes. The rates of healthcare-associated infections were low: 15 intravenous-line-related infections were recorded (0.3 per 1000 OPAT patient-days). Patient acceptance and satisfaction with OPAT were high. OPAT cost 15%, 39%, 40% and 44% of inpatient costs for an infectious diseases unit, national average costs, other departments (non-infectious diseases unit), and the minimum national average costs for each diagnostic category, respectively. This study shows that OPAT is safe, clinically efficacious and acceptable for treating a wide range of infections with high levels of patient satisfaction and substantial cost savings.

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“…Throughout the last few decades, evidence has been gathering in the medical literature on the safety of this treatment option for several clinical entities and, most importantly, for different infectious processes [9, 14]. More recently, good results have been reported in some clinical entities with a more surgical profile such as acute diverticulitis [15] and acute cholecystitis [16].…”

Section: Discussionmentioning

confidence: 99%

“…They are capable of providing levels of diagnosis, care, and treatment in their home for a limited time like those offered in the hospitals on which they depend [8]. Most HAH units are essentially managed by internal medicine specialists or family doctors and have the capacity to see to a broad variety of clinical processes such as intravenous domiciliary antibiotic treatment of various infections [9], pulmonary embolism, acute renal failure, and decompensations of chronic diseases such as heart failure [10] and COPD [11]. However, there are virtually no experiences published by HAH units on domiciliary care under the early discharge regimen of surgical patients during the immediate postoperative period.…”

Section: Introductionmentioning

confidence: 99%

Early Discharge Programme on Hospital-at-Home Evaluation for Patients with Immediate Postoperative Course after Laparoscopic Colorectal Surgery

et al. 2017

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Background: To audit the safety of the early hospital discharge care model offered by a Hospital-at-home (HAH) unit during early postoperative follow-up of these patients, and to determine whether this care model is more efficient compared to the traditional care model. Methods: A prospective study of 50 patients included consecutively for 1 year in an early discharge programme after laparoscopic colorectal surgery was performed. As of day 3 after surgery, if the patient met the relevant inclusion criteria they were transferred to the HAH unit. The domiciliary protocol consists of daily clinical follow-up and a series of analytical controls with the purpose of early detection of postoperative complications. If the clinical course was favourable on day 7 after the postoperative period the patient was discharged. Results: A total of 66% were males, and the mean age was 60.6 years. The surgical procedure most commonly performed was sigmoidectomy. The mean stay was 5.5 days. There were no deaths during follow-up. The average estimated cost per day of stay in a HAH system was EUR 174.29 whilst the same average cost on a surgery ward stood at EUR 1,032.42. Conclusions: For patients undergoing major colorectal surgery with minimally invasive surgical technique, an early hospital discharge care programme by means of referral to a HAH unit is a safe and efficient care model which entails a significant cost saving for the public healthcare system.

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Self-administered outpatient parenteral antimicrobial therapy (S-OPAT) for infective endocarditis: A safe and effective model

Cited by 27 publications

References 33 publications

Setting up an outpatient parenteral antimicrobial therapy (OPAT) unit in Switzerland: review of the first 18 months of activity

Setting up an outpatient parenteral antimicrobial therapy (OPAT) unit in Switzerland: review of the first 18 months of activity

Clinical efficacy, cost analysis and patient acceptability of outpatient parenteral antibiotic therapy (OPAT): a decade of Sheffield (UK) OPAT service

Early Discharge Programme on Hospital-at-Home Evaluation for Patients with Immediate Postoperative Course after Laparoscopic Colorectal Surgery

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