Widening the net: a literature review of antimicrobial agents with potential suitability for outpatient parenteral antimicrobial therapy services—the importance of storage and stability

2021 ◽  
pp. ejhpharm-2021-002937
Author(s):  
Abi Jenkins ◽  
Steven Shanu ◽  
Conor Jamieson ◽  
Mark Santillo
Keyword(s):  
Literature Review ◽  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Therapy Services

scholarly journals Outpatient parenteral antimicrobial therapy: updated recommendations from the UK

2019 ◽  
Vol 74 (11) ◽  
pp. 3125-3127 ◽  
Author(s):  
Ann L N Chapman ◽  
Sanjay Patel ◽  
Carolyne Horner ◽  
Mark Gilchrist ◽  
R Andrew Seaton
Keyword(s):  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Good Practice ◽  
Intravenous Therapy ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Stakeholder Consultation ◽  
Practice Recommendations ◽  
Recent Developments ◽  
Adults And Children ◽  
The Uk

Abstract Outpatient parenteral antimicrobial therapy (OPAT) offers safe, effective and patient-centred care for adults and children. The OPAT UK good practice recommendations for adults and children have recently been updated through a process of literature review, expert consensus and extensive stakeholder consultation. Here we discuss the key changes in the updated recommendations in the context of recent developments, including novel antimicrobial agents and delivery devices, the place of oral antimicrobials as an alternative to intravenous therapy, new OPAT service models and the broader antimicrobial stewardship agenda.

scholarly journals 1243. Comparative Analysis of Antimicrobial-related Adverse Events in the Outpatient Treatment of Staphylococcal Infections

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S378-S378
Author(s):  
Bradley Smith ◽  
Christina Rivera ◽  
Ross Dierkhising ◽  
Lynn Estes ◽  
John O’Horo ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Adverse Drug Events ◽  
Primary Objective ◽  
Gram Positive ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Staphylococcal Infections ◽  
Single Center Study ◽  
Therapy Modification

Abstract Background Limited data exist to evaluate safety-related outcomes in Outpatient Parenteral Antimicrobial Therapy (OPAT) patients treated with antimicrobial agents for Gram-positive infections. Methods This retrospective, single-center study enrolled Mayo Clinic OPAT patients between 2013 and 2017. The primary objective of the study compared rates of therapy modification due to drug-related toxicity for staphylococcal infections treated with ceftriaxone, cefazolin, nafcillin, oxacillin, vancomycin, daptomycin, ceftaroline, linezolid, or ertapenem. Secondary objectives included determination of the frequency and type of adverse drug events (ADEs) attributed to OPAT and rate of readmission due to ADEs attributed to OPAT. Results One hundred seventy-two patients were identified (cefazolin n = 54, ceftriaxone n = 49, vancomycin n = 30, daptomycin n = 16, nafcillin n = 9, ertapenem n = 6, ceftaroline n = 4, oxacillin n = 3, linezolid n = 1). The overall treatment completion rates were high (153/172, 89.0%). Patients completed an average of 35.3 days (7 to 95) of therapy with their original antibiotic. Fourteen patients required change to a different antibiotic due to antimicrobial toxicity (ceftriaxone=5; vancomycin=2; cefazolin = 2; daptomycin = 2; ceftaroline = 1; nafcillin = 1; oxacillin = 1) and five patients experienced treatment failure required an additional agent (ceftriaxone = 2; nafcillin = 2; linezolid = 1). Adverse drug events (ADEs) were the most common reason for antimicrobial adjustment (14/19, 73.7%). The most common ADEs were hypokalemia (28/172, 16.3%) and diarrhea (25/172, 14.5%). There were only two cases of Clostridium difficile. Thirty-day readmissions due to antimicrobial therapy were low with 11 patients. Conclusion OPAT with Gram-positive agents used for staphylococcal infections is effective, but antimicrobial modifications still occur. Clinicians should be aware of the risk of ADEs and readmissions in OPAT patients. A multidisciplinary approach may enhance management of ADEs and possibly preventing readmissions Disclosures All authors: No reported disclosures.

scholarly journals Experiences in outpatient parenteral antimicrobial therapy (OPAT): Barriers and challenges from the front lines

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Nicole Ng ◽  
Pamela Bailey ◽  
Rachel Pryor ◽  
Lillian Fung ◽  
Christine Veals ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Adverse Drug Events ◽  
Tertiary Care ◽  
Healthcare Spending ◽  
Healthcare Facility ◽  
Care Hospital ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Barriers And Challenges

Abstract Background: Outpatient parenteral antimicrobial therapy (OPAT) is now the standard of care for managing patients who no longer need inpatient care but require prolonged intravenous antimicrobial therapy. OPAT increases patient satisfaction, reduces the lengths of hospital stay, lowers emergency department readmission rates, and decreases total healthcare spending. Objective: To investigate Virginia Commonwealth University Health System’s experience with OPAT and to highlight the obstacles patients and clinicians face when navigating and utilizing this program. Design: We conducted this descriptive study at a large, academic, tertiary-care hospital in Central Virginia. Methods: We performed manual reviews of electronic medical records of 602 patient, and we evaluated the records of those receiving OPAT between 2017 and 2020. Reviews included antimicrobial agents, diagnoses requiring OPAT, adverse effects related to antimicrobials, adverse effects related to peripherally inserted central catheters (PICC), readmission rate, discharge destination, and death. We evaluated our program with descriptive statistics. Results: Among 602 patients who received OPAT, most were diagnosed with bacteremia or musculoskeletal infections. Patients were either discharged home or to another healthcare facility, with the former comprising most of the rehospitalizations. Ertapenem and vancomycin were associated with the most adverse drug events among our cohort. Elevated transaminase levels were noted in 23% of patients. The rate of PICC-line adverse events in this study population was 0.05%. Conclusions: Our findings highlight the barriers and challenges that patients and providers face when receiving OPAT, and they can inform efforts to improve patient clinical outcomes.

scholarly journals Cost-analysis of inpatient and outpatient parenteral antimicrobial therapy in orthopaedics: A systematic literature review

2019 ◽  
Vol 7 (14) ◽  
pp. 1825-1836 ◽  
Author(s):  
Christoph Kolja Boese ◽  
Philipp Lechler ◽  
Michael Frink ◽  
Michael Hackl ◽  
Peer Eysel ◽  
...  
Keyword(s):  
Literature Review ◽  
Cost Analysis ◽  
Systematic Literature Review ◽  
Antimicrobial Therapy ◽  
Outpatient Parenteral Antimicrobial Therapy

scholarly journals Antimicrobial Agents and Catheter Complications in Outpatient Parenteral Antimicrobial Therapy

2018 ◽  
Vol 38 (4) ◽  
pp. 476-481 ◽  
Author(s):  
Sara C. Keller ◽  
Kathryn Dzintars ◽  
Lisa A. Gorski ◽  
Deborah Williams ◽  
Sara E. Cosgrove
Keyword(s):  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Catheter Complications

scholarly journals Emergency Department Visits During Outpatient Parenteral Antimicrobial Therapy: A Cohort Study

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S333-S334
Author(s):  
So Lim Kim ◽  
Angela Everett ◽  
Susan J Rehm ◽  
Steven Gordon ◽  
Nabin Shrestha
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Hospital Admission ◽  
Vascular Access ◽  
Antimicrobial Therapy ◽  
Cleveland Clinic ◽  
Emergency Department Visits ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Ed Visits ◽  
Access Complications

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) carries risk of vascular access complications, antimicrobial adverse effects, and worsening of infection. Both OPAT-related and unrelated events may lead to emergency department (ED) visits. The purpose of this study was to describe adverse events that result in ED visits and risk factors associated with ED visits during OPAT. Methods OPAT courses between January 1, 2013 and December 31, 2016 at Cleveland Clinic were identified from the institution’s OPAT registry. ED visits within 30 days of OPAT initiation were reviewed. Reasons and potential risk factors for ED visits were sought in the medical record. Results Among 11,440 OPAT courses during the study period, 603 (5%) were associated with 1 or more ED visits within 30 days of OPAT initiation. Mean patient age was 58 years and 57% were males. 379 ED visits (49%) were OPAT-related; the most common visit reason was vascular access complication, which occurred in 211 (56%) of OPAT-related ED visits. The most common vascular access complications were occlusion and dislodgement, which occurred in 99 and 34 patients (47% and 16% of vascular access complications, respectively). In a multivariable logistic regression model, at least one prior ED visit in the preceding year (prior ED visit) was most strongly associated with one or more ED visits during an OPAT course (OR 2.96, 95% CI 2.38 – 3.71, p-value < 0.001). Other significant factors were younger age (p 0.01), female sex (p 0.01), home county residence (P < 0.001), and having a PICC (p 0.05). 549 ED visits (71%) resulted in discharge from the ED within 24 hours, 18 (2%) left against medical advice, 46 (6%) were observed up to 24 hours, and 150 ED visits (20%) led to hospital admission. Prior ED visit was not associated with hospital admission among patients who visited the ED during OPAT. Conclusion OPAT-related ED visits are most often due to vascular access complications, especially line occlusions. Patients with a prior ED visit in the preceding year have a 3-fold higher odds of at least one ED visit during OPAT compared with patients without a prior ED visit. A strategy of managing occlusions at home and a focus on patients with prior ED visits could potentially prevent a substantial proportion of OPAT-related ED visits. Disclosures All authors: No reported disclosures.

scholarly journals 623. Self-Administered Outpatient Parenteral Antimicrobial Therapy (S-OPAT) in Uninsured Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S371-S371
Author(s):  
Yasir Hamad ◽  
Jaspur Min ◽  
Yvonne Burnett
Keyword(s):  
Antimicrobial Therapy ◽  
Adverse Drug Events ◽  
Hospital Length ◽  
Clinic Visit ◽  
Hospital Length Of Stay ◽  
Uninsured Patients ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Joint Infections ◽  
Insured Patients ◽  
Hospital Days

Abstract Background Uninsured patients requiring long-term intravenous (IV) antimicrobials do not have access to outpatient parenteral antimicrobial therapy (OPAT) and often remain hospitalized for the duration of their treatment, transition to inferior oral antimicrobials, or leave against medical advice. A hospital-supported self-administered OPAT (S-OPAT) program was piloted in uninsured patients to decrease hospital length of stay and improve access to care. Methods Uninsured adult patients requiring IV antimicrobials were enrolled in an S-OPAT pilot study from July 2019 to April 2020. Patients with drug use history or documented non-adherence were excluded. S-OPAT patients attended weekly clinic visits for blood draws, dressing changes, and medication supply. The measured outcomes were hospital days saved, and potential income generated by earlier discharges. The latter was calculated by multiplying the number of hospital days saved by the daily charge for a hospital bed to insured patients. Results Seventeen patients were enrolled in S-OPAT, 14 (82%) were males, 8 (47%) were black, and the mean age was 39 years. The most common indication for OPAT was bone and joint infections in 12 (71%), and most commonly used antibiotic was ceftriaxone in 12 (71%) patients (Table). Early discontinuation occurred in 3 (17%) patients due to clinic visit non-adherence resulted in 2 (12%) and adverse drug events in 1 (6%). Only one (6%) patient had unplanned hospital readmission during OPAT. Transition to S-OPAT resulted in 533 hospital days avoided, and a net saving of approximately $900,000. Conclusion S-OPAT model is safe and can enhance care for uninsured patients while optimizing health-system resources. Table Disclosures All Authors: No reported disclosures

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