Galpérine T, Ader F, Piriou P, Judet T, Perronne C, Bernard L
Unité de maladies infectieuses, département de médecine aiguë spécialisée, assistance publique-Hôpitaux de Paris, hôpital universitaire Raymond-Poincaré, université de Versailles, Garches, France.
Med Mal Infect. 2006 Mar;36(3):132-7. doi: 10.1016/j.medmal.2006.01.002. Epub 2006 Mar 31.
The medical treatment of many bone and joint infections (including chronic osteomyelitis, prosthetic joint infection, and septic arthritis) requires prolonged intravenous antimicrobial therapy. For some patients, this treatment could be administered outside the hospital in a program that offers outpatient parenteral antimicrobial therapy (OPAT). In France, we have no registry of patients receiving OPAT. Initiation of this program requires specific criteria based on a patient evaluation and selection, and an interdisciplinary team of professionals committed to high-quality patient care. Various vascular access devices and infusion pump therapy are used to administer OPAT. The most common parenteral agents for OPAT are beta-lactams and glycopeptids (specifically vancomycin). Antimicrobial courses are stopped prematurely in 3 to 10% of the cases because of an adverse reaction or vascular access complications. Several published studies demonstrate the effectiveness of OPAT and higher patient satisfaction than hospital care. In addition, OPAT is clearly more cost-effective than intravenous therapy provided in the hospital setting. Some diagnoses, such as cellulites, community-acquired pneumonia, and endocarditis may be managed with OPAT.
许多骨与关节感染（包括慢性骨髓炎、人工关节感染和化脓性关节炎）的医学治疗需要长期静脉注射抗菌药物治疗。对于一些患者，这种治疗可以在医院外通过一个提供门诊胃肠外抗菌药物治疗（OPAT）的项目来进行。在法国，我们没有接受OPAT治疗患者的登记系统。启动该项目需要基于患者评估和选择的特定标准，以及一个致力于高质量患者护理的跨学科专业团队。各种血管通路装置和输液泵疗法用于实施OPAT。OPAT最常用的胃肠外药物是β-内酰胺类和糖肽类（特别是万古霉素）。由于不良反应或血管通路并发症，3%至10%的病例抗菌疗程会提前终止。多项已发表的研究表明OPAT有效，且患者满意度高于住院治疗。此外，OPAT显然比在医院环境中提供的静脉治疗更具成本效益。一些诊断，如蜂窝织炎、社区获得性肺炎和心内膜炎，也可以通过OPAT进行治疗。
