Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
Intern Med J. 2011 Sep;41(9):668-73. doi: 10.1111/j.1445-5994.2009.02136.x. Epub 2009 Dec 4.
Osteoarticular infections are a primary indication for outpatient parenteral antimicrobial therapy (OPAT). The climate and geographical diversity of tropical Australia, together with the prevalence of melioidosis, disseminated gonococcal disease and community-acquired methicillin-resistant Staphylococcus aureus renders this a challenging environment in which to manage such infections. We evaluated patients managed by the Royal Darwin Hospital Hospital in the Home service for bone and joint infections.
A retrospective analysis of the therapeutic outcomes at the end of intravenous therapy was carried out for patients treated between 1 January 2006 and 15 September 2007.
Fifty-five patients were treated, including 21 (38%) indigenous Australians and 18 (33%) from remote communities. Baseline characteristics were similar to other published data, but there were two cases each of gonococcal septic arthritis and melioidosis. During treatment, 39 (71%) lived at home, with five (9%) of these receiving treatment at community clinics. Thirteen (24%) resided in self-care units in the hospital grounds. Three (5%) were managed at hostels or in prison. Median duration of parenteral therapy was 42 days, with a median of 22 days outside hospital, providing a total saving of 1307 bed-days. Clinical success at end of therapy was 84%, with no significant difference between indigenous and non-indigenous cohorts.
OPAT for osteoarticular infections is both feasible and effective in a tropical environment, including for indigenous patients. Extension of treatment to remote-dwelling patients is facilitated by the innovative use of self-care units and administration of treatment at remote clinics.
骨关节感染是门诊静脉输注抗菌药物治疗（OPAT）的主要适应证。澳大利亚热带地区气候和地理条件多样，且存在类鼻疽、播散性淋病和社区获得性耐甲氧西林金黄色葡萄球菌感染，这使得管理此类感染极具挑战性。我们评估了皇家达尔文医院家庭治疗服务中骨关节感染患者的治疗结局。
对 2006 年 1 月 1 日至 2007 年 9 月 15 日期间接受治疗的患者，在静脉治疗结束时进行治疗结局的回顾性分析。
共治疗 55 例患者，包括 21 例（38%）土著澳大利亚人和 18 例（33%）来自偏远社区的患者。基线特征与其他已发表数据相似，但各有 2 例淋病性化脓性关节炎和类鼻疽感染。治疗期间，39 例（71%）患者居家治疗，其中 5 例（9%）在社区诊所接受治疗。13 例（24%）居住在医院内的自理单元。3 例（5%）在招待所或监狱中接受治疗。静脉治疗的中位持续时间为 42 天，中位院外治疗时间为 22 天，共节省 1307 个床位日。治疗结束时临床治愈率为 84%，土著和非土著患者之间无显著差异。
OPAT 治疗骨关节感染在热带环境中是可行且有效的，包括土著患者。通过创新使用自理单元和在偏远诊所进行治疗，为居住在偏远地区的患者延长治疗提供了便利。
