Maximising the opportunity of a self-administration outpatient parenteral antimicrobial therapy pathway

Clinical and patient-reported outcomes of self-administered outpatient parenteral antimicrobial treatment (S-OPAT): a scoping review

PURPOSE

This study aimed to provide a comprehensive overview of the existing literature on Self-administered Outpatient Parenteral Antimicrobial Therapy (S-OPAT), focusing on safety and clinical outcomes, factors influencing these outcomes, and the experiences of patients and caregivers.

METHODS

We searched the databases MEDLINE, CINAHL, Embase and Cochrane library. Publications were included if they reported on the clinical outcomes, safety, and/or experiences of patients and caregivers with S-OPAT. Study selection and data extraction were performed independently by two reviewers. Quantitative and qualitative data were summarized in data charting forms.

RESULTS

Forty-four studies were included: 41 primary studies, 2 systematic reviews and 1 clinical guideline. Clinical outcomes were reported in 17 and safety in 23 primary studies. Eleven studies compared S-OPAT to other OPAT delivery models. These studies showed that all models were generally comparable regarding clinical outcomes, but two studies reported an increased number of adverse events with S-OPAT. Nine studies, exploring a total of 7 potential risk factors, identified older age, comorbidities and Staphylococcus aureus infections as contributors to adverse events. The results of 14 studies on patient-centred outcomes showed that patients and caregivers considered S-OPAT a suitable alternative to other OPAT delivery models.

CONCLUSION

We conclude that S-OPAT is a viable model of care, demonstrating favourable clinical outcomes, although some safety concerns have been reported. The growing care demand now and in the future urges further development of S-OPAT care. Gaps of knowledge still exist, and we provide recommendations for future research.

The environmental impact of intravenous antimicrobial therapies: a comparison of OPAT and inpatient administration care pathways

Objectives

The urgent global threats of the climate crisis and antimicrobial resistance have the potential to be addressed in part by increasing the use of outpatient antimicrobial therapy (OPAT). Our study aimed to appraise the environmental impact of three commonly used OPAT pathways, and the traditional inpatient model of IV antimicrobial therapy.

Methods

We assessed the CO2, waste and water footprint associated with self-care, nurse assisted and outpatient OPAT care pathways and inpatient administration of intravenous antibiotics to adult patients for whom OPAT was a viable treatment option.

Results

We found that the administration of IV antibiotics in hospital is associated with a substantial environmental impact compared to OPAT. When OPAT is self-administered in the patient's home, we discovered a CO2 reduction of 85%, a water use reduction of 78% and a 91% reduction in the amount of waste generated compared with the traditional inpatient treatment pathway. Nurse administered OPAT, either in the home or outpatient department, also results in lower use of water, generation of waste and CO2 emissions compared to the inpatient pathway.

Conclusions

Our study demonstrates that using OPAT reduces the environmental impact of delivering antimicrobial therapy compared to inpatient treatment. As it is delivered away from the hospital setting, it may also reduce the risks to health associated with inpatient care. While we have shown that the reduction in CO2 emissions, water used and waste generated is significant for all three forms of OPAT studied, the greatest impact is seen with the use of self-administration OPAT.

A Service Model Guide to Outpatient Parenteral Antimicrobial Therapy (OPAT)

Outpatient parenteral antimicrobial therapy (OPAT) involves delivery of antibiotic medication outside a hospital setting, offering benefits such as patient convenience and cost-effectiveness. This guide to establishing an OPAT program covers patient selection, antibiotic and device choices, as well as patient safety and various models of care.

Home nursing and self-administered outpatient parenteral antimicrobial treatment: a comparison of demographics and outcomes from a large regional hospital in Queensland, Australia

BACKGROUND

Outpatient parenteral antimicrobial treatment (OPAT) is a safe and effective therapy used in several settings across Australia. As OPAT services expand their inclusion criteria to include complex patient populations, there is an increased need for selecting appropriate patients to receive either healthcare-administered OPAT (H-OPAT) or self-administered OPAT (S-OPAT).

AIMS

To describe patient demographics, diagnosis, microbiology and outcomes of patients treated by H-OPAT and S-OPAT within the Sunshine Coast Hospital and Health Service, Australia.

METHODS

Data on demographics, diagnoses, treatment and outcomes on all patients treated by H-OPAT and S-OPAT from March 2017 to December 2019 were collected retrospectively.

RESULTS

One hundred and sixty-five patients (62.26%) were enrolled in H-OPAT and 100 patients (37.74%) in S-OPAT. S-OPAT patients were significantly younger. H-OPAT patients were more comorbid. Bone and joint infections were the most treated infections and were more likely to be treated by S-OPAT. There was no difference in treatment duration, cure and complication rates between S-OPAT and H-OPAT. Longer duration of therapy was associated with more complications. Treatment failure was associated with infections due to multiple organisms, number of comorbidities and treatment of surgical site, skin and soft tissue infections.

CONCLUSIONS

There were significant differences in demographics between H-OPAT and S-OPAT without any difference in outcomes. Overall failure and complication rates were low. Higher rates of treatment failure were predicted by the diagnosis, number of comorbidities and number of organisms treated.

Effectiveness and safety of a disposable elastomeric continuous infusion pump for outpatient parenteral antimicrobial therapy (OPAT) in a UK setting

We evaluated the effectiveness and safety of continuous antimicrobial infusion using a disposable elastomeric device in an outpatient parenteral antimicrobial therapy (OPAT) setting. We conducted a retrospective analysis of all patients who received either flucloxacillin (n = 131 episodes) or piperacillin/tazobactam (n = 301 episodes) as continuous infusion via elastomeric devices over 5 years (January 2018-December 2022) at a tertiary referral hospital in Derbyshire, UK. Overall, 81 adverse events were recorded in 77 (18%; 77/432) patient-episodes. Most adverse events were vascular access-related (59%; 4.6 events per 1000 OPAT-days), including one line-related infection (0.2%; 0.1 events per 1000 OPAT-days). 165 (38%) patient-episodes experienced at least one incident of incomplete infusion. Successful outcome (cure or improvement) occurred in 364 (84%) episodes. Our findings suggest that elastomeric infusion pumps are safe and effective for administering selected antimicrobial agents in OPAT. However, close monitoring of patients and the device are essential to ensure optimal delivery of prescribed therapy.

Risk of venous thromboembolism in outpatient parenteral antimicrobial therapy (OPAT): A systematic review and meta-analysis

The risk of venous thromboembolism (VTE) in outpatient parenteral antimicrobial therapy (OPAT) is not fully understood and the optimal strategy for thromboprophylaxis remains unclear. This systematic review investigated the incidence of VTE in OPAT settings (PROSPERO CRD42022381523). MEDLINE, CINAHL, Emcare, Embase, Cochrane Library and grey literature were searched from earliest records to 18 January 2023. Primary studies reporting non-catheter-related VTE or catheter-related thromboembolism (CRT) events in adults who received parenteral antibiotics in home or outpatient settings were eligible. In total, 43 studies involving 23 432 patient episodes were reviewed, of which 4 studies reported non-catheter-related VTE and 39 included CRT. Based on generalised linear mixed-effects models, pooled risk estimates of non-catheter-related VTE and CRT were 0.2% [95% confidence interval (CI) 0.0-0.7%] and 1.1% [95% CI 0.8-1.5%; prediction interval (PI) 0.2-5.4%]. Heterogeneity was largely attributed to risk of bias by meta-regression (R2 = 21%). Excluding high-risk-of-bias studies, CRT risk was 0.8% (95% CI 0.5-1.2%; PI 0.1-4.5%). From 25 studies, the pooled CRT rate per 1000 catheter-days was 0.37 (95% CI 0.25-0.55; PI 0.08-1.64). These findings do not support universal thromboprophylaxis or routine use of an inpatient VTE risk assessment model in the OPAT setting. However, a high index of suspicion should be maintained, especially for patients with known risk factors for VTE. An optimised protocol of OPAT-specific VTE risk assessment should be sought.