Outpatient parenteral antibiotic therapy (OPAT) for bone and joint infections: Experience from a UK teaching hospital-based service
ABSTRACT We describe failure rates of 198 patients with bone and joint infection (BJI), including prosthetic joint infection and diabetic foot osteomyelitis, managed through the Glasgow centre for outpatient parenteral antibiotic therapy (OPAT) over a period of 4 years. Outcomes following initial intravenous antimicrobial therapy and a median follow-up time of 60 weeks are described.
A prospectively maintained registry of all patients attending OPAT was examined for cases of BJI. Once identified, patient case records were reviewed and data extracted. Diagnosis, demographics, microbiology and treatment were recorded, and case records were examined for evidence of failing initial prescribed OPAT therapy and up to 24 months of follow-up.
One hundred and ninety-eight cases of BJI were identified. The overall success rate following initial OPAT was 86.4%, with a range from 71.8% success rate for diabetic foot or stump infection (DFI) to 100% for metalwork-related infection. The failure rate over the follow-up period was 29.8%. Factors associated with poor initial outcome included older age, methicillin-resistant Staphylococcus aureus infection and DFI, factors that continued to explain failure up to 24 months in multivariate survival analysis.
For the majority of conditions, BJI can be successfully managed through OPAT. Identification of those likely to respond less well, including older patients, those with DFI and those with infections by resistant organisms, may encourage enhanced vigilance and consideration of newer or more aggressive treatments in these subgroups of patients.
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ABSTRACT: Use of outpatient parenteral antimicrobial therapy (OPAT) is increasing in settings with advanced healthcare systems internationally. This study describes a large OPAT service cohort developed in the west of Scotland and includes trends over a 10-year period of this service. Data were retrieved from a prospectively maintained electronic case database. Patient and logistic variables were collated for all OPAT episodes (n=2638, resulting in 39035 days of patient care over 10 years). Skin and soft-tissue infections and bone and joint infections accounted for 77% of OPAT cases, but a wide range of other conditions have been treated in this cohort. Outcome variables were evaluated for all first OPAT attendances (n=2233), amongst which a successful outcome (cure or improvement) was found for 2063 (92.4%). Unplanned admission was observed in 9.1% of patients (6.3 events per 1000 OPAT patient days). Healthcare-associated infection rates were low: amongst first OPAT attendances, 14 intravenous line infections were observed (0.4 per 1000 OPAT patient days). Statistically significant trends over time included: a decrease in OPAT treatment time; increased referrals from non-local and secondary care sources; increased rate of co-morbidity of OPAT referrals; and increased self/carer administration of antimicrobials. Outcome proportions (success and adverse events) did not vary over time. This cohort study adds to the increasing observational data suggesting that OPAT is safe, effective and acceptable for treating a wide variety of infections. Observed trends over a 10-year period suggest that this model of infection management is adaptable and sustainable.International journal of antimicrobial agents 03/2012; 39(5):407-13. DOI:10.1016/j.ijantimicag.2012.01.016 · 4.26 Impact Factor