手术患者的门诊肠外抗菌治疗：与既往标准治疗的比较。
Outpatient parenteral antimicrobial therapy for surgery patients: A comparison with previous standard of care.
机构信息
Department of Pharmacy, University Health Network (Princess Margaret Cancer Centre site);
Department of Medicine, Division of Infectious Diseases, University Health Network (Toronto General Hospital site);
出版信息
Can J Infect Dis Med Microbiol. 2013 Summer;24(2):74-8. doi: 10.1155/2013/754897.
BACKGROUND
Current literature reports that outpatient parenteral antimicrobial therapy (OPAT) programs improve cure rates, and reduce length of hospitalization and costs. OPAT programs are still relatively new in Canada.
OBJECTIVE
To evaluate the benefits of an OPAT program initiated at a multispecialty tertiary care facility in Toronto, Ontario, compared with the previous standard of care.
METHODS
The present retrospective observational study was conducted using data from a group of surgical patients who were treated for active infections. Between February 1, 2010 and November 30, 2010, a total of 108 surgical patients were enrolled in the OPAT program. Patients were matched 1:1 with historical controls discharged between January 1, 2001 and January 1, 2010 according to age, sex, type of surgery, infection and comorbidities (Charlson Comorbidity Index). Cure rate, 30-day rehospitalization and length of stay were evaluated as primary end points.
RESULTS
Of 108 eligible OPAT patients, 21 were matched to the control group using the prespecified criteria. For this cohort, the OPAT program was associated with improved cure rates (OPAT 61.7% versus control 57.1%; P>0.10), reduction in rehospitalization rate (14.3% versus 28.6%; P>0.10) and reduced length of stay (10.7 versus 13.9 days, P>0.10) compared with the control group.
CONCLUSIONS
For this cohort of surgery patients, the OPAT program demonstrated a trend toward improved outcomes but did not achieve statistical significance. Due to the lack of statistical power, further evaluation is required to determine the full benefit of OPAT to patients and the health care system.
背景
当前的文献报道称，门诊患者的抗菌药物治疗（OPAT）项目可提高治愈率，并减少住院时间和费用。OPAT 项目在加拿大仍相对较新。
目的
评估在安大略省多伦多市的一家多专科三级保健机构启动的 OPAT 项目与之前的护理标准相比的优势。
方法
本回顾性观察性研究使用一组接受积极感染治疗的外科患者的数据进行。2010 年 2 月 1 日至 2010 年 11 月 30 日，共有 108 例外科患者入组 OPAT 项目。根据年龄、性别、手术类型、感染和合并症（Charlson 合并症指数），将患者与 2001 年 1 月 1 日至 2010 年 1 月 1 日出院的历史对照患者 1:1 匹配。治愈率、30 天再住院率和住院时间作为主要终点进行评估。
结果
在 108 例符合条件的 OPAT 患者中，根据预设标准，有 21 例与对照组匹配。对于这组患者，OPAT 项目与提高治愈率（OPAT 为 61.7%，对照组为 57.1%；P>0.10）、降低再住院率（14.3%比 28.6%；P>0.10）和缩短住院时间（10.7 天比 13.9 天，P>0.10）相关。
结论
对于这组外科患者，OPAT 项目显示出改善结局的趋势，但未达到统计学意义。由于缺乏统计学效力，需要进一步评估以确定 OPAT 对患者和医疗保健系统的全部益处。
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