1
|
Stoorvogel HH, Hulscher MEJL, Wertheim HFL, Yzerman EPF, Scholing M, Schouten JA, ten Oever J. Current Practices and Opportunities for Outpatient Parenteral Antimicrobial Therapy in Hospitals: A National Cross-Sectional Survey. Antibiotics (Basel) 2022; 11:antibiotics11101343. [PMID: 36290001 PMCID: PMC9598700 DOI: 10.3390/antibiotics11101343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
This nationwide study assessed how outpatient parenteral antimicrobial therapy (OPAT) is organised by Dutch acute care hospitals, the barriers experienced, and how an OPAT program affects the way hospitals organised OPAT care. We systematically developed and administered a survey to all 71 Dutch acute care hospitals between November 2021 and February 2022. Analyses were primarily descriptive and included a comparison between hospitals with and without an OPAT program. Sixty of the 71 hospitals (84.5%) responded. Fifty-five (91.7%) performed OPAT, with a median number of 20.8 (interquartile range [IQR] 10.3-29.7) patients per 100 hospital beds per year. Of these 55 hospitals, 31 (56.4%) had selection criteria for OPAT and 34 (61.8%) had a protocol for laboratory follow-up. Sixteen hospitals (29.1%) offered self-administered OPAT (S-OPAT), with a median percentage of 5.0% of patients (IQR: 2.3%-10.0%) actually performing self-administration. Twenty-five hospitals (45.5%) had an OPAT-related outcome registration. The presence of an OPAT program (22 hospitals, 40.0%) was significantly associated with aspects of well-organised OPAT care. The most commonly experienced barriers to OPAT implementation were a lack of financial, administrative, and IT support and insufficient time of healthcare staff. Concluding, hospital-initiated OPAT is widely available in the Netherlands, but various aspects of well-organised OPAT care can be improved. Implementation of a team-based OPAT program can contribute to such improvements. The observed variation provides leads for further scientific research, guidelines, and practical implementation programs.
Collapse
Affiliation(s)
- Hester H. Stoorvogel
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Internal Medicine & IQ Healthcare, Radboud Center for Infectious Diseases, 6500HB Nijmegen, The Netherlands
- Correspondence:
| | - Marlies E. J. L. Hulscher
- Radboud University Medical Center, Department of IQ Healthcare, Radboud Center for Infectious Diseases, 6500HB Nijmegen, The Netherlands
| | - Heiman F. L. Wertheim
- Radboud University Medical Center, Department of Medical Microbiology, Radboud Center for Infectious Diseases, 6500HB Nijmegen, The Netherlands
| | - Ed P. F. Yzerman
- ABR Zorgnetwerk Noord-Holland–Flevoland, 1105AZ Amsterdam, The Netherlands
| | - Maarten Scholing
- ABR Zorgnetwerk Noord-Holland–Flevoland, 1105AZ Amsterdam, The Netherlands
- OLVG Lab BV, 1091AC Amsterdam, The Netherlands
| | - Jeroen A. Schouten
- Radboud University Medical Center, Department of Intensive Care & IQ Healthcare, Radboud Center for Infectious Diseases, 6500HB Nijmegen, The Netherlands
| | - Jaap ten Oever
- Radboud University Medical Center, Department of Internal Medicine, Radboud Center for Infectious Diseases, 6500HB Nijmegen, The Netherlands
| |
Collapse
|
2
|
Ortonobes S, Mujal-martínez A, de Castro Julve M, González-sánchez A, Jiménez-pérez R, Hernández-ávila M, De Alfonso N, Maye-pérez I, Valle-delmás T, Rodríguez-sánchez A, Pino-garcía J, Gómez-valent M. Successful Integration of Clinical Pharmacists in an OPAT Program: A Real-Life Multidisciplinary Circuit. Antibiotics (Basel) 2022; 11:1124. [PMID: 36009993 PMCID: PMC9404975 DOI: 10.3390/antibiotics11081124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/08/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
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.
Collapse
|
3
|
Wee LE, Sundarajoo M, Quah WF, Farhati A, Huang JY, Chua YY. Health-related quality of life and its association with outcomes of outpatient parenteral antibiotic therapy. Eur J Clin Microbiol Infect Dis 2019; 39:765-772. [PMID: 31873862 DOI: 10.1007/s10096-019-03787-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 12/02/2019] [Indexed: 01/09/2023]
Abstract
While health-related quality of life (HRQoL) is an important component of patient-centred care, few studies have looked at the association between HRQoL and outcomes while on OPAT. From 2014 to 2017, we conducted a prospective cohort study of all patients referred to Singapore General Hospital's (SGH) OPAT service. At baseline, we collected sociodemographic, clinical, and treatment-related factors for OPAT recipients. We also measured baseline HRQoL using the EuroQoL EQ5D-3 L. We evaluated the association between HRQoL and the following outcomes: complications experienced while on OPAT, early termination requiring readmission during planned course of OPAT, all-cause readmission 30 days after completion of OPAT, and return to work while on OPAT. We used chi-squared test for univariate analysis and cox regression for multivariate analysis. From 2014 to 2017, 1213 patients received OPAT at our centre. Of those, 13.2% (160/1213) developed complications. About 10% (132/1213) of patients were readmitted while on OPAT and OPAT was terminated early. Amongst patients who completed OPAT (N = 1081), about 3.6% (39/1081) were readmitted within 30 days after OPAT completion. About half (50.8%, 278/547) returned to work while on OPAT. On multivariate analysis, patients with perfect health-related quality of life (HRQoL) (adjusted relative risk, aRR = 0.62, 95%CI = 0.45-0.85) were less likely to experience complications, had lower risk of OPAT termination (aRR = 0.57, 95%0.38-0.86), and were more likely to return to work while on OPAT (aRR = 1.94, 95%CI = 1.30-2.89). HRQoL at baseline was significantly associated with lower risk of complications and early OPAT termination, as well as greater likelihood of return to work while on OPAT.
Collapse
Affiliation(s)
- Liang En Wee
- Duke-NUS Graduate Medical School, Singapore, Singapore. .,Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore.
| | | | - Way-Fang Quah
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Ahmad Farhati
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Jie-Ying Huang
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Ying-Ying Chua
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| |
Collapse
|
4
|
Chapman ALN, Patel S, Horner C, Green H, Guleri A, Hedderwick S, Snape S, Statham J, Wilson E, Gilchrist M, Seaton RA. Updated good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) in adults and children in the UK. JAC Antimicrob Resist 2019; 1:dlz026. [PMID: 34222901 PMCID: PMC8209972 DOI: 10.1093/jacamr/dlz026] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
UK good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) were published in 2012 and 2015 for adult and paediatric patients, respectively. Here we update the initial good practice recommendations in a combined document based on a further review of the OPAT literature and an extensive consultation process. As with the previous good practice recommendations, these updated recommendations are intended to provide pragmatic guidance for new and established OPAT services across a range of settings and to act as a set of quality indicators for service evaluation and quality improvement.
Collapse
Affiliation(s)
| | - Sanjay Patel
- Southampton Children’s Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Carolyne Horner
- The British Society for Antimicrobial Chemotherapy, Birmingham, UK
| | - Helen Green
- Southampton Children’s Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Achyut Guleri
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | | | - Susan Snape
- Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - Julie Statham
- South Warwickshire NHS Foundation Trust, Warwick, UK
| | | | | | - R Andrew Seaton
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| |
Collapse
|
5
|
Wee LE, Sundarajoo M, Quah WF, Farhati A, Huang JY, Chua YY. Sociodemographic and clinical factors associated with acceptance of outpatient parenteral antibiotic therapy in a Singapore tertiary hospital from 2014 to 2017. Eur J Clin Microbiol Infect Dis 2018; 38:277-284. [PMID: 30430375 DOI: 10.1007/s10096-018-3424-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/06/2018] [Indexed: 11/26/2022]
Abstract
Outpatient parenteral antibiotic therapy (OPAT) can facilitate early discharge; however, not all offered OPAT can accept. We assessed factors associated with acceptance of OPAT in a large Asian tertiary hospital cohort. From 2014 to 2017, we reviewed all referrals to Singapore General Hospital's (SGH) Outpatient Parenteral Antibiotic Therapy (OPAT) service. We compared differences in sociodemographic and clinical factors between patients who opted for OPAT and those who declined, using chi-square test for univariate analysis and logistic regression for multivariate analysis. From 2014 to 2017, a total of 1406 OPAT referrals were made. Of these, 95.9% (1349/1406) were deemed suitable for OPAT. Amongst those suitable, 90.0% (1213/1349) accepted OPAT treatment. On multivariate analysis, being independently ambulant (aOR = 3.46, 95%CI = 2.21-5.37) was independently associated with higher odds of acceptance for OPAT; whereas, patients with peripheral vascular disease had lower odds of accepting OPAT (aOR = 0.32, 95%CI = 0.16-0.62). Lower socioeconomic status (SES) was closely associated with rejection of OPAT, with markers of both individual-level SES (subsidized ward class) and area-level SES (staying in a public rental flat) being independently associated with lower odds of OPAT preference. Distance and travel time were not associated with OPAT acceptance. The top reasons for rejecting OPAT were lack of caregiver (n = 35), mobility issues (n = 24), financial issues (n = 24), and difficulty caring for the line (n = 21). Comorbidities, mobility, and financial issues are important factors to consider when determining suitability for OPAT. More can be done to improve accessibility of OPAT amongst lower-income patients and those staying in lower-SES areas.
Collapse
Affiliation(s)
- Liang En Wee
- Adjunct Research Fellow, Duke-NUS Graduate Medical School, Singapore, Singapore.
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore.
| | | | - Way-Fang Quah
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Ahmad Farhati
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Jie-Ying Huang
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Ying-Ying Chua
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| |
Collapse
|
6
|
Rudrabhatla P, Deepanjali S, Mandal J, Swaminathan RP, Kadhiravan T. Stopping the effective non-fluoroquinolone antibiotics at day 7 vs continuing until day 14 in adults with acute pyelonephritis requiring hospitalization: A randomized non-inferiority trial. PLoS One 2018; 13:e0197302. [PMID: 29768465 PMCID: PMC5955556 DOI: 10.1371/journal.pone.0197302] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/29/2018] [Indexed: 02/07/2023] Open
Abstract
Objective To evaluate whether stopping the effective antibiotic treatment following clinical improvement at Day 7 (Truncated treatment) would be non-inferior to continued treatment until Day 14 (Continued treatment) in patients with acute pyelonephritis (APN) requiring hospitalization treated with non-fluoroquinolone (non-FQ) antibiotics. Methods Hospitalized adult men and non-pregnant women with culture-confirmed APN were eligible for participation after they had clinically improved following empirical or culture-guided treatment with intravenous non-FQ antibiotic(s). We excluded patients with severe sepsis, abscesses, prostatitis, recurrent or catheter-associated urinary tract infection, or urinary tract obstruction. We randomized eligible patients on Day 7 of effective treatment and assessed them at Weeks 1 and 6 after treatment completion. The primary outcome was retreatment for recurrent urinary tract infection. The prespecified non-inferiority margin was 15%. Results Between March 17, 2015 and August 22, 2016, we randomly allocated 54 patients—27 patients in each arm. Twenty-four (44%) patients were male, and 26 (48%) had diabetes mellitus. Escherichia coli was the most common urinary isolate (47 [87%] patients); 36 (78%) were resistant to ciprofloxacin. In all, 41 (76%) patients received amikacin-based treatment. At the end of 6 weeks, no patient in the truncated treatment arm required retreatment, whereas 1 patient in the continued treatment arm was retreated. Difference (90% CI) in retreatment was −3.7% (−15.01% to 6.15%). Upper bound of the difference (6.15%) was below the prespecified limit, establishing non-inferiority of truncated treatment. Asymptomatic bacteriuria at Week 6 was similar between the two arms (3/24 vs. 3/26; P = 1.0). Patients in the truncated treatment arm had significantly shorter hospital stay (8 [7–10] vs. 14 [14–15] days; P < 0.001) and less antibiotic consumption per patient (8.4 ± 2.8 vs. 17.4 ± 8.3 DDDs; P < 0.001). Conclusion Stopping the effective non-FQ antibiotics following clinical improvement at Day 7 is non-inferior to continued treatment until Day 14 in selected patients with APN requiring hospitalization. Trial registration Clinical Trials Registry-India; CTRI/2016/04/006810.
Collapse
Affiliation(s)
- Pavankumar Rudrabhatla
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Surendran Deepanjali
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
- * E-mail:
| | - Jharna Mandal
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Tamilarasu Kadhiravan
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| |
Collapse
|