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. 2025 Oct 31.
doi: 10.1007/s15010-025-02671-0. Online ahead of print.

Continuous infusion OPAT via elastomeric pumps: effectiveness, safety, and cost-saving potential in a real-world Italian cohort

Stella Babich  1 , Stefano Di Bella  1   2 , Raffaele De Rivo  3 , Oyewole Christopher Durojaiye  4   5 , Antonio Lovecchio  1 , Andrea Misin  1 , Madalina Straciug  1 , Ylenia Gobbo  1 , Angela Dellaluce  1 , Michela Palmolungo  6 , Massimiliano Fabricci  7 , Filippo Giorgio Di Girolamo  2   8 , Chiara Roni  8 , Jacopo Monticelli  9   10
Affiliations

Continuous infusion OPAT via elastomeric pumps: effectiveness, safety, and cost-saving potential in a real-world Italian cohort

Stella Babich et al. Infection. .

Abstract

Purpose: To evaluate clinical outcomes, safety, patient-reported satisfaction, and cost-effectiveness of elastomeric pump-based Outpatient Parenteral Antimicrobial Therapy (OPAT) over six years at an Italian tertiary center.

Methods: This retrospective single-center study included 76 adult patients treated with continuous-infusion OPAT via elastomeric pumps between 2019 and 2024 at the University Hospital of Trieste, Italy.

Results: A total of 1,934 elastomeric pump-based OPAT days were delivered (median duration of 22.9 days). Clinical cure was achieved in 85.5% of patients; recurrence and failure occurred in 6.2% and 7.9%, respectively. Most frequent indications were skin/soft tissue and surgical site infections (25.9%), complicated urinary tract infections (22.4%), and bone/joint infections (16.4%). Pathogens were mainly Gram-negative (70.7%), including Enterobacterales (40.2%, 57.6% ESBL-producing), Pseudomonas aeruginosa (26.8%), and Staphylococcus aureus (17.1%, 28.6% methicillin-resistant S. aureus). The most used antibiotics were piperacillin/tazobactam (51.3%), cefepime (12.5%) and ceftolozane/tazobactam (7.5%). Adverse events were observed in 13.75% of treatments, primarily vascular access-related (5.7 events/1,000 OPAT-days); drug-related adverse events occurred in 7.8% of patients (3.1 events/1,000 OPAT-days). Among contacted patients (75% response rate), 83.7% expressed willingness to reuse the pump. Total OPAT costs were €62,190.64 compared to an estimated €773,600.00 for inpatient care, yielding a 92% cost reduction (€711,409 saved).

Conclusion: Elastomeric pump-based OPAT is a clinically effective, well-tolerated, and economically advantageous option for selected infections. Its integration into stewardship programs supports broader implementation within modern, sustainable infectious disease care models.

Keywords: Antimicrobial stewardship; Continuous infusion; Cost-analysis; Elastomeric pumps; OPAT.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethical approval: This study was conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments. Ethical approval was granted by the Ethics Committee of the University of Trieste. Informed consent: Due to the retrospective nature of the study, the requirement for informed consent was waived in accordance with institutional and national guidelines.

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