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. 2013 Summer;24(2):74-8.
doi: 10.1155/2013/754897.

Outpatient parenteral antimicrobial therapy for surgery patients: A comparison with previous standard of care

Anjie Yang  1 , Ron Fung  1 , James Brunton  2 , Linda Dresser  3
Affiliations

Outpatient parenteral antimicrobial therapy for surgery patients: A comparison with previous standard of care

Anjie Yang et al. Can J Infect Dis Med Microbiol. 2013 Summer.

Abstract
in English, French

Background: Current literature reports that outpatient parenteral antimicrobial therapy (OPAT) programs improve cure rates, and reduce length of hospitalization and costs. OPAT programs are still relatively new in Canada.

Objective: To evaluate the benefits of an OPAT program initiated at a multispecialty tertiary care facility in Toronto, Ontario, compared with the previous standard of care.

Methods: The present retrospective observational study was conducted using data from a group of surgical patients who were treated for active infections. Between February 1, 2010 and November 30, 2010, a total of 108 surgical patients were enrolled in the OPAT program. Patients were matched 1:1 with historical controls discharged between January 1, 2001 and January 1, 2010 according to age, sex, type of surgery, infection and comorbidities (Charlson Comorbidity Index). Cure rate, 30-day rehospitalization and length of stay were evaluated as primary end points.

Results: Of 108 eligible OPAT patients, 21 were matched to the control group using the prespecified criteria. For this cohort, the OPAT program was associated with improved cure rates (OPAT 61.7% versus control 57.1%; P>0.10), reduction in rehospitalization rate (14.3% versus 28.6%; P>0.10) and reduced length of stay (10.7 versus 13.9 days, P>0.10) compared with the control group.

Conclusions: For this cohort of surgery patients, the OPAT program demonstrated a trend toward improved outcomes but did not achieve statistical significance. Due to the lack of statistical power, further evaluation is required to determine the full benefit of OPAT to patients and the health care system.

Historique: D’après les rapports bibliographiques actuels, les programmes d’antibiothérapie parentérale ambulatoire (ATPA) améliorent les taux de guérison et réduisent la durée d’hospitalisation et les coûts. Les programmes d’ATPA sont encore relativement nouveaux au Canada.

Objectif: Évaluer les avantages d’un programme d’ATPA lancé dans un centre de soins tertiaires multidisciplinaire de Toronto, en Ontario, par rapport aux normes de soins antérieures.

Méthodologie: Les chercheurs ont mené la présente étude d’observation rétrospective à l’aide des données d’un groupe de patients opérés traités en raison d’infections actives. Entre le 1er février et le 30 novembre 2010, 108 patients opérés ont été inscrits au programme d’ATPA. Les patients ont été jumelés 1:1 avec des sujets témoins historiques qui ont obtenu leur congé entre le 1er janvier 2001 et le 1er janvier 2010 d’après leur âge, leur sexe, le type d’opération, l’infection et les comorbidités (indice de comorbidité de Charlson). Les paramètres principaux étaient le taux de guérison, la réhospitalisation au bout de 30 jours et la durée d’hospitalisation.

Résultats: Sur les 108 patients du programme d’ATPA admissibles, 21 ont été jumelés au groupe témoin au moyen des critères pré-définis. Dans cette cohorte, le programme d’ATPA s’associait à un meilleur taux de guérison (61,7 % pour l’ATPA par rapport à 57,1 % pour le groupe témoin; P>0,10), à une réduction du taux de réhospitalisation (14,3 % par rapport à 28,6 %; P>0,10) et à diminution de la durée d’hospitalisation (10,7 par rapport à 13,9 jours, P>0,10) que dans le groupe témoin.

Conclusions: Auprès de cette cohorte de patients opérés, le programme d’ATPA démontrait une tendance vers de meilleures issues, sans pour autant avoir de signification statistique. En raison de l’absence d’efficacité statistique, il faudra approfondir l’évaluation afin de déterminer les avantages du programme d’ATPA pour les patients et le système de santé.

Keywords: Home parenteral antimicrobial therapy; OPAT; Outpatient parenteral antimicrobial therapy.

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Figures

Figure 1)
Figure 1)
Screening process. Due to the very large initial term of derivation (11,291 vascular access device [VAD] courses) for control patients, Excel (Microsoft Corporation, USA) was used for filtering the initial steps. Patients were determined to be using the VAD for antimicrobial purposes by the reported descriptions in the database. Once antimicrobial courses were determined, the rest of the screening process was performed manually. Feb February; IV Intravenous; Jan January; OPAT Outpatient parenteral antimicrobial therapy
Figure 2)
Figure 2)
Schematic diagram of the matching process undertaken. Due to the stringent matching criteria, only 21 of the 108 outpatient parenteral antimicrobial therapy (OPAT) patients had a matched control. CV Cardiovascular; Feb February; Nov November
Figure 3)
Figure 3)
Clinical status at the end of therapy for both groups. OPAT Outpatient parenteral antimicrobial therapy
Figure 4)
Figure 4)
Rate of 30-day rehospitalization for both groups. OPAT Outpatient parenteral antimicrobial therapy
Figure 5)
Figure 5)
Mean hospital length of stay for both groups
See this image and copyright information in PMC

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References

    1. Tice A, Rehm SH, Dalovisio JR, et al. Practice guidelines for outpatient parenteral antimicrobial therapy. Clin Infect Dis. 2004;38:1651–65. - PubMed
    1. Gilchrist M, Franklin BD, Patel JP. An outpatient parenteral antibiotic therapy (OPAT) map to identify risks associated with an OPAT service. J Antimicrob Chemother. 2008;52:177–83. - PubMed
    1. Kieran J, O’Reilly A, Parker J, Clarke S, Bergin C. Self-administered outpatient parenteral antimicrobial therapy: A report of three years experience in the Irish healthcare setting. Eur J Clin Microbiol Infect Dis. 2009;28:1369–74. - PubMed
    1. American Society of Health-System Pharmacists ASHP guidelines on the pharmacist’s role in home care. Am J Health-Syst Pharm. 2000;57:1252–7. - PubMed
    1. Nathwani D. Developments in outpatient parenteral antimicrobial therapy (OPAT) for Gram-positive infections in Europe, and the potential impact of daptomycin. J Antimicrob Chemother. 2009;64:447–53. - PubMed

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