Outpatient parenteral antibiotic therapy (OPAT) for bone and joint
infections: experience from a UK teaching hospital-based service
C. L.Mackintosh1*†, H. A. White2† and R. A.Seaton1
1The Infection, Tropical Medicine and Counselling Centre, Brownlee Unit, Gartnavel General Hospital, 1053 Great Western Road, Glasgow
G12 0YN, Scotland, UK;2Department of Infectious Diseases, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK
*Corresponding author. Tel: +44-141-2110292; Fax: +44-141-2111097; E-mail: email@example.com
†Both these authors contributed equally to this work.
Received 10 September 2010; returned 9 October 2010; revised 28 October 2010; accepted 28 October 2010
Objectives: 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.
Patients and methods: 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 pre-
scribed OPAT therapy and up to 24 months of follow-up.
Results: 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.
Conclusions: 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.
Keywords: antibiotics, bacterial infections, diabetic foot infections, MRSA
Over the last 30 years, outpatient parenteral antibiotic therapy
(OPAT) has come into mainstream clinical care in the USA and
is increasingly used in Europe.1–3Reduction in the risk of
healthcare-associated infection, quicker return to work or edu-
cation for the patient, improvement in quality of life for those
requiring long-term antimicrobial therapy and reduction in
healthcare costs4,5are all important patient and health system
Numerically, skin and soft tissue infections are the most
common infections treated (usually with short-term therapy),
whilst bone and joint infections (BJIs), including prosthetic joint
infection,6are the second most common treatment group. Such
courses of intravenous (iv) antibiotics in otherwise healthy
patients and, therefore, are well suited to management via
OPAT. Despite this, there is a paucity of published data specifically
reporting outcomes of patients treated in this setting.5,7–10
We report the outcome of 198 patients with BJI, including
prosthetic joint infection and diabetic foot osteomyelitis,
managed through the Glasgow OPAT centre over a period of
4 years. Among this heterogeneous group of conditions, we
show that OPAT can be used to deliver treatment with high
success rates for some conditions and, amongst those who do
less well, we identify factors that may contribute to their poor
Patients and methods
This was a retrospective series of all cases of BJI managed at the
Glasgow OPAT centre (based at The Brownlee Unit, Gartnavel General
Hospital, Glasgow, UK) between January 2001 and December 2005.
The OPAT service during this period comprised two full-time specialist
# The Author 2010. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
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J Antimicrob Chemother 2011; 66: 408–415
doi:10.1093/jac/dkq445 Advance Access publication 30 November 2010
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17 Esposito S, Leone S, Noviello S et al. Foot infections in diabetes (DFIs)
in the out-patient setting: an Italian multicentre observational survey.
Diabet Med 2008; 25: 979–84.
18 Upton A, Ellis-Pegler RB, Woodhouse A. Outpatient parenteral
antimicrobial therapy (OPAT): a review of experience at Auckland
Hospital. N Z Med J 2004; 117: U1020.
19 Tice AD, Hoaglund PA, Shoultz DA. Outcomes of osteomyelitis among
patients treated with outpatient parenteral antimicrobial therapy. Am J
Med 2003; 114: 723–8.
20 White HA, Davis JS, Kittler P et al. Outpatient parenteral antimicrobial
therapy-treated bone and joint infections in a tropical setting. Intern Med
J 2009; doi:10.1111/j.1445-5994.2009.02136.x.
21 Choong PF, Dowsey MM, Carr D et al. Risk factors associated with
acute hip prosthetic joint infections and outcome of treatment with a
rifampin-based regimen. Acta Orthop 2007; 78: 755–65.
22 Pavoni GL, Giannella M, Falcone M et al. Conservative medical
therapy of prosthetic joint infections: retrospective analysis of an 8-year
experience. Clin Microbiol Infect 2004; 10: 831–7.
Management of bone and joint infections through OPAT
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