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G Suleyman, R Kenney, M J Zervos, A Weinmann
WHAT IS KNOWN AND OBJECTIVE: Outpatient parenteral therapy (OPAT) has become a safe and effective modality for patients requiring intravenous or prolonged antimicrobial therapy since the 1970s. It is being increasingly utilized in various settings; however, studies evaluating the safety and efficacy of clinic-based OPAT are limited. Since 2012, patients being considered for OPAT have required an infectious disease (ID) consultation at our institution. Candidates receiving once-daily antimicrobials who were ineligible for home infusion or nursing home placement as determined by their insurance companies and those who preferred the clinic over nursing home or home infusion were referred to the ID clinic...
October 16, 2016: Journal of Clinical Pharmacy and Therapeutics
M Alexander, R Beattie-Manning, R Blum, J Byrne, C Hornby, C Kearny, N Love, J McGlashan, S McKiernan, J L Milar, D Murray, S Opat, P Parente, J Thomas, N Tweddle, C Underhill, K Whitfield, S Kirsa, D Rischin
These guidelines, informed by the best available evidence and consensus expert opinion, provide a framework to guide the timely initiation of chemotherapy for treating cancer. They sit at the intersection of patient experience, state-of-the-art disease management and rational efficient service provision for these patients at a system level. Internationally, cancer waiting times are routinely measured and publicly reported. In Australia, there are existing policies and guidelines relating to the timeliness of cancer care for surgery and radiation therapy; however, until now, equivalent guidance for chemotherapy was lacking...
August 2016: Internal Medicine Journal
Susanna van Der Merwe, Helen Green
AIM: Outpatient parenteral antimicrobial therapy (OPAT), both in children and adults, is increasing in use as part of a cost saving measure for the NHS.1 However there is a general lack of stability data for antibiotics in elastomeric devices. The 'Yellow Covered Document'2 (YCD), as it is commonly known, specifies the storage conditions, under which stability testing should be carried out ranging from freezing to a worst case scenario of 37°C±2°C. It is assumed that a temperature of 37°C equates to wearing a device reservoir under clothing close to the body e...
September 2016: Archives of Disease in Childhood
Marliese Alexander, Robert Blum, Sachin Joshi, Stephen Opat, Phillip Parente, Kate Burbury, John Coutsouvelis, Michael Dooley, Obaid Fazil, Tina Griffitths, Huda Ismail, Natalie Love, Nicole Porter, Eldene Ross, Jim Siderov, Pauline Thomas, Shane White, Sue Kirsa, Danny Rischin
This review evaluated the association between time-to-chemotherapy (TTC) and survival in six priority cancers. A systematic review of the literature was undertaken for papers indexed in MEDLINE and Cochrane Library databases from earliest index until April 2014. The methodology used has been published in a separate paper (Timely initiation of chemotherapy. Part 1: a proposed framework for access to medical oncology and haematology cancer clinics and chemotherapy services). The optimal timing of chemotherapy in breast cancer is unclear as available studies are of low quality, report inconsistent results, and are limited to the adjuvant setting...
July 11, 2016: Internal Medicine Journal
Laura Means, Susan Bleasdale, Monica Sikka, Alan E Gross
STUDY OBJECTIVE: Outpatient parenteral antimicrobial therapy (OPAT) is increasingly used, and unfortunately, readmissions during OPAT are common. The purpose of this study was to identify predictors of hospital readmission among patients receiving OPAT. DESIGN: Retrospective cohort study. SETTING: Large academic tertiary care hospital. PATIENTS: A total of 216 adults who were discharged and received OPAT through a peripherally inserted central catheter for at least 2 days for treatment of an active infection, excluding patients with cystic fibrosis, between January 2012 and August 2013...
August 2016: Pharmacotherapy
Silvano Esposito, Silvana Noviello, Giovanni Boccia, Giuseppe De Simone, Pasquale Pagliano, Francesco De Caro
This study aimed to assess the extent and nature of recent changes in the management of outpatient parenteral antimicrobial therapy (OPAT) in Italy. We reviewed our previously reported data from 1999 to 2003 and compared them with data from patients who received OPAT from 2005 to 2010. Data for 1175 patients who received OPAT were analysed. Skin and soft tissue infections (SSTIs) were the most common infection treated with OPAT in both time periods, but an increase in patients with SSTIs receiving OPAT was observed...
June 1, 2016: Le Infezioni in Medicina
Marie Yan, Marion Elligsen, Andrew E Simor, Nick Daneman
Outpatient parenteral antimicrobial therapy (OPAT) is a safe and effective alternative to hospitalization for many patients with infectious diseases. The objective of this study was to describe the OPAT experience at a Canadian tertiary academic centre in the absence of a formal OPAT program. This was achieved through a retrospective chart review of OPAT patients discharged from Sunnybrook Health Sciences Centre within a one-year period. Between June 2012 and May 2013, 104 patients (median age 63 years) were discharged home with parenteral antimicrobials...
2016: Canadian Journal of Infectious Diseases & Medical Microbiology
P R Ingram, M D M Rawlins, R J Murray, J A Roberts, L Manning
In the context of globally increasing antimicrobial resistance, tigecycline appears to be a useful therapeutic option. The need for prolonged courses for complex infections has prompted consideration of its use via outpatient parenteral antibiotic therapy (OPAT) programmes, although clinical outcomes when used in this setting remain unknown. We retrospectively reviewed the patient characteristics and outcomes of 11 patients who received tigecycline, most commonly delivered as 100 mg once daily, via OPAT at three tertiary Australian hospitals...
October 2016: European Journal of Clinical Microbiology & Infectious Diseases
Estelle Moulin, Noémie Boillata, Serge De Vallière
With the increase of infections without option for an oral treatment, the systematic use of hospitalization overloads the healthcare system and causes growing political concern. For carefully selected patients, outpatient parenteral antibiotic therapy is an interesting alternative, with more than 40 years of experience in several countries. In this perspective, an outpatient parenteral antibiotic therapy (OPAT) unit was established in Lausanne two years ago. This article aims to describe its activity. Its practice, involving especially self-administration, seems to be safe, efficacious and cost-effective, as long as international good practice recommendations are applied...
April 13, 2016: Revue Médicale Suisse
Marek Štefan, Michal Holub
Traditionally, parenteral (i. e. intravenous) antimicrobial therapy has been used in inpatients with various bacterial infections. In recent decades there has been growing experience with outpatient parenteral antimicrobial therapy, mainly in the USA and western Europe. This article provides basic information on OPAT, based on available literature and the author´s experience on running OPAT service in the UK.
2016: Casopís Lékar̆ů C̆eských
Jaime E Verastegui, Yukihiro Hamada, David P Nicolau
Acute bacterial skin and skin structure infections (ABSSSI) have evolved over a relatively short period of time to become one of the most challenging medical problems encountered in clinical practice. Notably the high incidence of methicillin-resistant S. aureus (MRSA) across the continuum of care has coincided with increased outpatient failures and higher rates of hospital admissions for parental antibiotic therapy. Consequently the management of ABSSSI constitutes a tremendous burden to the healthcare system in terms of cost of care and consumption of institutional and clinical resources...
August 2016: Expert Review of Clinical Pharmacology
Mohamad-Ali Trad, Lihua H Zhong, Ryan M Llorin, Shire Yang Tan, Monica Chan, Sophia Archuleta, Zuraidah Sulaiman, Vincent H Tam, David C Lye, Dale A Fisher
BACKGROUND: Ertapenem is a broad-spectrum antibiotic that is increasingly being utilized. Its dosing convenience renders it suitable for outpatient therapy, and its pharmacokinetic characteristics favour its use against complicated urinary tract infections (cUTIs). Despite this, sufficient clinical data are lacking for its use against cUTIs in the outpatient setting. We assessed the microbiological and clinical cure rates associated with ertapenem treatment for cUTIs in two outpatient parenteral antimicrobial therapy (OPAT) departments...
May 30, 2016: Journal of Chemotherapy
Ivar S Jensen, Elizabeth Wu, Weihong Fan, Thomas P Lodise, David P Nicolau, Scott Dufour, Philip L Cyr, Katherine A Sulham
BACKGROUND: It is estimated that acute bacterial skin and skin structure infections (ABSSSI) account for nearly 10% of hospital admissions and 3.4-3.8 million emergency department visits per year in the United States. Analyses of hospital discharge records indicate 74% of ABSSSI admissions involve empiric treatment with methicillin-resistant Staphylococcus aureus (MRSA) active antibiotics. Analysis has shown that payer costs could be reduced if moderate-to-severe ABSSSI patients were treated to a greater extent in the observational unit followed by discharge to outpatient parenteral antibiotic therapy (OPAT)...
June 2016: Journal of Managed Care & Specialty Pharmacy
Tine Ravelingien, Franky Buyle, Sabine Deryckere, Erica Sermijn, Mieke Debrauwere, Katleen Verplancke, Steven Callens, Sabrina Commeyne, Christophe Pattyn, Dirk Vogelaers
OBJECTIVES: Some infections require prolonged parenteral antimicrobial therapy, which can be continued in an outpatient setting. The Ghent University Hospital has 15 years of experience with Outpatient Parenteral Antimicrobial Therapy (OPAT) in the home setting of the patient. METHODS: Multidisciplinary critical approach through identification of areas for improvement with the existing OPAT process within the Ghent University Hospital. Existing literature and guidelines were used as references...
May 19, 2016: Acta Clinica Belgica
Kate A Hodgson, Julie Huynh, Laila F Ibrahim, Bronwyn Sacks, Daniel Golshevsky, Michael Layley, Mark Spagnolo, Chin-Mae Raymundo, Penelope A Bryant
OBJECTIVE: Outpatient parenteral antimicrobial therapy (OPAT) is increasingly used to treat children at home, but studies in children are scarce. We aimed to describe the use, appropriateness and outcomes of OPAT in children. DESIGN: This was a 12-month prospective observational study. SETTING: The hospital-in-the-home programme of The Royal Children's Hospital Melbourne. PATIENTS: All patients receiving OPAT. INTERVENTIONS: Data were collected including demographics, diagnosis, type of venous access and antibiotic choice...
October 2016: Archives of Disease in Childhood
Alison M Beieler, Timothy H Dellit, Jeannie D Chan, Shireesha Dhanireddy, Leslie K Enzian, Tamera J Stone, Edward Dwyer-O'Connor, John B Lynch
BACKGROUND: Outpatient parenteral antimicrobial therapy (OPAT) is a safe way to administer intravenous (IV) antimicrobial therapy to patients with the potential to decrease hospital length of stay (LOS). Often, homeless patients with complex infections, who could otherwise be treated as an outpatient, remain in the hospital for the duration of IV antibiotic treatment. Injection drug use (IDU) is a barrier to OPAT. OBJECTIVE: To evaluate our experience with administering OPAT to homeless patients at a medical respite facility and determine if patients could complete a successful course of antibiotics...
August 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Priscila Rosalba Oliveira, Cassia da Silva Felix, Vladimir Cordeiro de Carvalho, Arlete Mazzini Giovani, Rosangela Suarti Dos Reis, Marisa Beraldo, Edmir Peralta Albuquerque, Walter Cintra Ferreira, Jorge Dos Santos Silva, Ana Lucia Lei Lima
Treatment of orthopedic infections usually requires prolonged antimicrobial therapy, ranging from 14 days up to 6 months. Nowadays, rising levels of antimicrobial resistance demands parenteral therapy for many patients. Outpatient parenteral antimicrobial therapy (OPAT) is a modality that allows treatment out of hospital in these situations. In Brazil, where a public universal healthcare system allows full coverage for all citizens, implantation and dissemination of OPAT programs would be beneficial for patients and for the system, because it would allow a better allocation of health resources...
May 2016: Brazilian Journal of Infectious Diseases
John J Veillette, Puja Van Epps
OBJECTIVE: To report a case of ertapenem-induced hallucinations and delirium in an elderly, morbidly obese patient. SETTING/PRACTICE DESCRIPTION: A 71-year-old male was receiving intravenous antibiotics at an outside nursing facility through our Outpatient Parenteral Antimicrobial Therapy (OPAT) program, which has enrolled more than 800 patients since 2009. He was admitted to our medical center, a 673-bed tertiary health care facility, which provides care to more than 100,000 veterans in Northeast Ohio...
April 2016: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
Francisco Javier Candel, Agustin Julián-Jiménez, Juan González-Del Castillo
Outpatient parenteral antimicrobial therapy (OPAT) programs are a current and widely spread trend in clinical practice because of it's a cost-effective option, it's associated with a greater comfort for the patient, a lower risk of nosocomial complications and an important cost saving for the health care system. OPAT is used for treating a wide range of infections, including skin and soft tissue infections, osteoarticular infections, bacteraemia, endocarditis and complex intra-abdominal and urinary tract infections, even in presence of multiresistant microorganisms...
April 2016: Revista Española de Quimioterapia: Publicación Oficial de la Sociedad Española de Quimioterapia
Manuel Mirón-Rubio, Víctor González-Ramallo, Oriol Estrada-Cuxart, Pedro Sanroma-Mendizábal, Antonio Segado-Soriano, Abel Mujal-Martínez, Manuel Del Río-Vizoso, Mario García-Lezcano, Natalia Martín-Blanco, Lidia Florit-Serra, Mercè Gil-Bermejo
AIM: To evaluate outpatient parenteral antimicrobial therapy (OPAT) in the hospital-at-home (HaH) model, using data from a Spanish registry. PATIENTS & METHODS: We describe episodes/characteristics of patients receiving OPAT. RESULTS: Four thousand and five patients were included (mean age 66.2 years), generating 4416 HaH episodes, 4474 infections and 5088 antibiotic treatments. Most patients were from the hospital admission ward and emergency department...
2016: Future Microbiology
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