A Review of Outpatient Parenteral Antimicrobial Therapy Practices
INTRODUCTION
Outpatient parenteral antimicrobial therapy (OPAT) was first introduced in 1974, and its use has been increasing steadily, particularly in the past 20 years. The development of new antibiotics that can be administered daily, improvements in vascular access and drug administration devices, and the emphasis on cost containment have played important roles in the evolution of OPAT. The guidelines of the Infectious Diseases Society of America (IDSA) define OPAT as the intravenous, intramuscular, or subcutaneous administration of at least 2 doses of an antimicrobial agent, on 2 different days, without admission to hospital. OPAT is usually administered to expedite hospital discharge of patients who need continued parenteral antimicrobial therapy, although it may also be used to avoid hospital admission altogether. A variety of infections, including skin and soft-tissue infections, endocarditis, pneumonia, and osteomyelitis, have been treated successfully with OPAT.
Although device-related and antimicrobial-related adverse events have been recognized, OPAT has many advantages. This type of therapy is as effective and safe as therapy provided in hospital and has the advantage of lower costs; patients also prefer outpatient therapy. The use of OPAT has led to shorter hospital stays and lower hospital-associated costs and should also reduce the potential for nosocomial infections. Viagra Super Active
The literature describing OPAT programs in Canada is limited. Experience with OPAT has been described for hospitals in Vancouver, Calgary Manitoba, the province of Quebec, and Hamilton; the institutions differed in the structure of their programs and in selection of antimicrobials. The Ottawa Hospital is an 1100-bed, multicampus, university-affiliated teaching hospital; the hospital has 2 acute care campuses (Civic and General) and encompasses the University of Ottawa Heart Institute. Although OPAT is frequently prescribed at this institution, its use has not been reviewed, and no formal OPAT program exists. Rather, OPAT is organized on an individual basis, and follow-up is structured at the discretion of each treating physician. Therefore, the health records of patients who were treated at The Ottawa Hospital and the University of Ottawa Heart Institute and who received OPAT were reviewed, with the goal of describing the patient population, indications, antimicrobial selection, complications, and patient outcomes for this type of therapy.
