A Review of Outpatient Parenteral Antimicrobial Therapy Practices: DISCUSSION
The objective of this study was to review current practices related to OPAT for adult patients treated at The Ottawa Hospital and the University of Ottawa Heart Institute. This review allowed description of the patients who received OPAT, the extent of involvement of infectious disease specialists in the care of these patients, the most common diagnoses and antimicrobial regimens used, and the complications and outcomes that occurred. During the 1-year study period, 236 patients received OPAT.
There were similarities and differences between the experience reported here and that described for other OPAT programs. Of the patients who received OPAT in this study, there were slightly more patients who had been admitted to hospital (53%) than were discharged from the emergency department (44%). The majority of patients discharged from the Vancouver Hospital and Health Sciences Center were also inpatients, whereas in Calgary and at the Hopital Charles LeMoyne in Greenfield Park, Quebec, most of the patients enrolled in the OPAT program originated from the emergency department. A variety of infections, including wound infections, osteomyelitis, endocarditis, and abscesses, were treated at The Ottawa Hospital and the University of Ottawa Heart Institute; cellulitis was the most common diagnosis (42% of patients). The American OPAT Outcomes Registry has reported skin and soft-tissue infections (23%), osteomyelitis (15%), septic arthritis or bursitis (5%), bacteremia (5%), wound infection (4%), pneumonia (4%), and pyelonephritis (3%) as the most common infections treated with OPAT.
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The differences between the US registry data and the findings from the study reported here may be due to the small sample size of this study and/or differences in patient populations. Other Canadian hospitals have reported skin and soft-tissue infections, bone and joint infections, and endocarditis as the infections most frequently treated with OPAT, consistent with the findings reported here.
In this review, the majority (82%) of OPAT patients were treated with a single antimicrobial agent. The most common agent used as monotherapy was either a penicillin or cephalosporin. This finding is unsurprising, given that beta-lactams can be used to treat a variety of infections and are generally safe and well tolerated. Monotherapy was also more common in Quebec and Manitoba, whereas combination therapy was reported more often in Vancouver. The OPAT Outcomes Registry in the United States listed ceftriaxone and vancomycin as the top 2 antibiotics used for OPAT. The most commonly prescribed antimicrobial at The Ottawa Hospital and the University of Ottawa Heart Institute was cefazolin. kamagra soft tabs
The average duration of OPAT (27.3 days) observed in this review was comparable to the duration of therapy in the Vancouver program (22.5 days). In Calgary, however, most patients were treated for less than 7 days. This discrepancy may be explained by the high incidence of soft-tissue infections (64%) in the Calgary program.
