Article

Outpatient parenteral antibiotic therapy (OPAT) for bone and joint infections: Experience from a UK teaching hospital-based service

The Infection, Tropical Medicine and Counselling Centre, Brownlee Unit, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, Scotland, UK.
Journal of Antimicrobial Chemotherapy (Impact Factor: 5.44). 11/2010; 66(2):408-15. DOI: 10.1093/jac/dkq445
Source: PubMed

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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    • "This composite endpoint included unplanned readmission or surgery during OPAT, adverse drug reaction leading to a switch in antimicrobial therapy or readmission, or development of antibiotic resistance. We have previously used this approach to identify factors associated with OPAT failure for other infections,8,12 and it is supported by recently published OPAT good practice recommendations.13 "
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    ABSTRACT: Objectives To identify risk factors for failure of outpatient antibiotic therapy (OPAT) in infective endocarditis (IE). Patients and methods We identified IE cases managed at a single centre over 12 years from a prospectively maintained database. ‘OPAT failure’ was defined as unplanned readmission or antibiotic switch due to adverse drug reaction or antibiotic resistance. We analysed patient and disease-related risk factors for OPAT failure by univariate and multivariate logistic regression. We also retrospectively collected follow-up data on adverse disease outcome (defined as IE-related death or relapse) and performed Kaplan–Meier survival analysis up to 36 months following OPAT. Results We identified 80 episodes of OPAT in IE. Failure occurred in 25/80 episodes (31.3%). On multivariate analysis, cardiac or renal failure [pooled OR 7.39 (95% CI 1.84–29.66), P = 0.005] and teicoplanin therapy [OR 8.69 (95% CI 2.01–37.47), P = 0.004] were independently associated with increased OPAT failure. OPAT failure with teicoplanin occurred despite therapeutic plasma levels. OPAT failure predicted adverse disease outcome up to 36 months (P = 0.016 log-rank test). Conclusions These data caution against selecting patients with endocarditis for OPAT in the presence of cardiac or renal failure and suggest teicoplanin therapy may be associated with suboptimal OPAT outcomes. Alternative regimens to teicoplanin in the OPAT setting should be further investigated.
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