A Review of Outpatient Parenteral Antimicrobial Therapy Practices: METHODS
The study protocol was approved by the Research and Ethics Boards of The Ottawa Hospital and the University of Ottawa Heart Institute. Patients who were treated at either of these institutions between November 1, 2003, and October 31, 2004, and who received OPAT were identified for this review by the Community Care Access Centre (CCAC), which coordinates OPAT in the Ottawa region. Of these, a convenience sample of 75 patient charts (i.e., every third patient) was chosen. In the context of this study, “outpatient” was defined as a patient receiving therapy at home or in a clinic; parenteral therapy was limited to IV administration. Patients could be included more than once if they had received multiple, nonconcurrent OPAT courses for multiple infections; however, no patients in the identified sample had nonconcurrent courses of therapy. The CCAC obtained verbal consent from the selected patients before the chart review.
The charts were reviewed to determine the indication, admitting service, antimicrobial regimen selected, concurrent use of warfarin or oral contraceptives (to assess potential drug interactions), monitoring plan, complications, and outcome of therapy. Requests and results for laboratory investigations, culture and susceptibility testing, and serum levels of antibiotic were recorded as part of the monitoring assessment, when available.
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Outcomes were categorized as “successful”, “successful with complications”, or “failed”. The outcome was considered “successful” if the initial antimicrobial course was completed as prescribed and “successful with complications” if the patient completed OPAT for the original infection but experienced an adverse event or complication, whether or not a change in therapy was required. The outcome was considered “failed” if OPAT was discontinued prematurely because of an adverse event or complication. Worsening of the infection or readmission to hospital for reasons attributable to the infection being treated were also classified as “failed”.
