Safety of an Out-Patient Intravenous Antibiotics Programme

Transcription

1 Safety of an Out-Patient Intravenous Antibiotics Programme Chan VL, Tang ESK, Leung WS, Wong L, Cheung PS, Chu CM Department of Medicine & Geriatrics United Christian Hospital

2 Outpatient Parental Antimicrobial Therapy (OPAT) First described in 1974 Wide-spread use in USA Provided to 1 in 1000 American each year Advantage of OPAT Cost containment Better acceptance by patients

3 Outpatient Parental Antimicrobial Therapy (OPAT) Provision of parental antimicrobial therapy in an outpatient setting Home Physician s offices Hospital-based ambulatory care clinics Emergency departments Skilled nursing or long-term care facilities Rehabilitation centers Parental Intramuscular Intravenous

4 Community-acquired pneumonia CAP is a very significant health issue Not all patients are suitable for outpatient oral antibiotics treatment Pneumonia in UCH Period:1/1/ /12/2005 Total episodes = 2608 Total patients = 2232 Mean length of acute hospital stay = 6.85 days

5 OPAT for pneumonia Outpatient IV antibiotic treatment for pneumonia were comparable to inpatient treatment with the potential to reduce length of hospital stay Morales et al. Am J Med.1994; 97(2A):28-33.

6 Outpatient intravenous antibiotics programme in UCH Established in 2000 Carried out in dayward

7 Aim To audit the safety and effectiveness of the outpatient intravenous antibiotics programme for community-acquired pneumonia (CAP)

8 Methods Retrospective audit Study period 1st Jan th June 2005 Patients enrolled Admitted for community-acquired pneumonia Required parental antibiotics treatment according to international guideline and clinical decision by physicians Achieved stable clinical condition, but still need to be continued on intravenous antimicrobial therapy Discharged with outpatient once-daily intravenous antibiotics (Ceftriaxone)

9 Assessment for OPAT Is intravenous antibiotic needed? Is the home or outpatient environment safe and adequate to support care Patient and/or caregiver participation Close monitor during outpatient treatment

10 Exclusion criteria History of hypersensitivity reactions to cepholosporin or penicillin Likely to receive other parental therapy concurrently Had a concurrent illness requiring inpatient care Home environment considered not conductive to outpatient care

11 Evaluation Complication related to parental antibiotic therapy Rash, urticaria, anaphylaxis, fever Gastrointestinal symptoms Renal or hepatic impairment Leukopenia, anemia Phlebitis Complication of pneumonia Persistent fever or CXR infiltrate Empyema or lung abscess formation Outcome Cure complete clearance of pneumonic symptoms Improved improvement in pneumonic symptoms Re-admission Death

12 Results 79 patients 42 male (53.2%), 37 female (46.8%) Mean age 53.2 ± 18.7, range Length of hospital stay Mean 4.38 ± 2.42 days

13 Results Outpatient intravenous antibiotic treatment Daily dose of iv ceftriaxone 1 g (70.9% patients) 2 g (29.1% patients) Duration of outpatient intravenous treatment Mean 3.50 ± 1.38 days (range 1-7 days)

14 Outcome Complication of outpatient intravenous antibiotic treatment was uncommon Phlebitis = 1 (1.3%) Required re-insertion of catheter = 4 (5.1%) Dis-contiuation due to drug-related adverse events = 0

15 Outcome Pneumonia outcome at the end of antibiotic treatment Cured = 57 patients (72.2%) Improved = 18 patients (22.8%) Re-admission = 4 patients (5%) None due to clinical failure Heart failure = 1 Pleural effusion = 2» Simple reactive effusion only Persistent CXR infiltrate = 1» Later confirmed to be pulmonary carcinoid tumor Death = 0

16 Summary Outpatient intravenous antibiotic programme for community-acquired pneumonia is safe and effective

17 Applications Infections treated with outpatient parental antimicrobial therapy (OPAT) Skin and soft tissue infection Osteomyelitis, septic arthritis Bacteremia Pneumonia Pyelonephritis Antibiotics used in OPAT Ceftriaxone Vancomycin Cefazolin Oxacillin/nafcillin Aminoglycosides Penicillin, cephalosporins Antivirals» Practice guidelines for OPAT. CID 2004:38:

18 Conclusion Out-patient, once-daily intravenous antibiotics treatment for communityacquired pneumonia is safe and effective Potential role in reducing demands for hospital beds Potential application in treatment for other infections

19 Microbiological results Streptococcus pneumonia Haemophilus influenza Moraxella pneumonia Other Gram ve organism Mycoplasma pneumonia Legionella pneumonia Influenza A virus Number of patients 6 (PRSP=5) Percentage 7.6 (PRSP=6.3) Total PRSP= Penicillin Resistant Strep. Pneumonia