Connors William J, Rabie Heidi H, Figueiredo Rafael L, Holton Donna L, Parkins Michael D
Department of Medicine, University of Calgary, Foothills Medical Centre, 1403, 29th Street NW, Room 303, 3rd Floor North Tower, Calgary, AB, T2N 2T9, Canada.
Division of Infectious Diseases, Department of Medicine, Clinical Lecturer - University of Calgary, Foothills Medical Centre, 1403 29th Street NW, Room 303, 3rd Floor North Tower, Calgary, AB, T2N 2T9, Canada.
BMC Infect Dis. 2017 Mar 9;17(1):202. doi: 10.1186/s12879-017-2303-2.
The number of Acute Dental Infections (ADI) presenting for emergency department (ED) care are steadily increasing. Outpatient Parenteral Antibiotic Therapy (OPAT) programs are increasingly utilized as an alternative cost-effective approach to the management of serious infectious diseases but their role in the management of severe ADI is not established. This study aims to address this knowledge gap through evaluation of ADI referrals to a regional OPAT program in a large Canadian center.
All adult ED and OPAT program ADI referrals from four acute care adult hospitals in Calgary, Alberta, were quantified using ICD diagnosis codes in a regional reporting system. Citywide OPAT program referrals were prospectively enrolled over a five-month period from February to June 2014. Participants completed a questionnaire and OPAT medical records were reviewed upon completion of care.
Of 704 adults presenting to acute care facilities with dental infections during the study period 343 (49%) were referred to OPAT for ADI treatment and 110 were included in the study. Participant mean age was 44 years, 55% were women, and a majority of participants had dental insurance (65%), had seen a dentist in the past six months (65%) and reported prior dental infections (77%), 36% reporting the current ADI as a recurrence. Median length of parenteral antibiotic therapy was 3 days, average total course of antibiotics was 15-days, with a cumulative 1326 antibiotic days over the study period. There was no difference in total duration of antibiotics between broad and narrow spectrum regimes. Conservative cost estimate of OPAT care was $120,096, a cost savings of $597,434 (83%) compared with hospitalization.
ADI represent a common preventable cause of recurrent morbidity. Although OPAT programs may offer short-term cost savings compared with hospitalization, risks associated with extended antibiotic exposures and delayed definitive dental management must also be gauged.
前往急诊科就诊的急性牙感染（ADI）病例数量正在稳步增加。门诊胃肠外抗生素治疗（OPAT）项目越来越多地被用作管理严重传染病的一种具有成本效益的替代方法，但其在严重ADI管理中的作用尚未明确。本研究旨在通过评估加拿大一个大型中心向区域OPAT项目转诊的ADI病例来填补这一知识空白。
在一个区域报告系统中，使用国际疾病分类诊断代码对来自艾伯塔省卡尔加里市四家成人急症医院的所有成人急诊科和OPAT项目的ADI转诊病例进行量化。在2014年2月至6月的五个月期间，前瞻性纳入全市OPAT项目的转诊病例。参与者完成一份问卷，并在护理结束后审查OPAT病历。
在研究期间，704名因牙感染到急症护理机构就诊的成人中，343例（49%）被转诊至OPAT进行ADI治疗，110例被纳入研究。参与者的平均年龄为44岁，55%为女性，大多数参与者有牙科保险（65%），在过去六个月内看过牙医（65%），并报告有既往牙感染（77%），36%报告当前的ADI为复发。胃肠外抗生素治疗的中位时长为3天，抗生素的平均总疗程为15天，在研究期间累计有1326个抗生素日。广谱和窄谱治疗方案的抗生素总时长没有差异。OPAT护理的保守成本估计为120,096美元，与住院治疗相比节省成本597,434美元（83%）。
ADI是复发性发病的常见可预防原因。虽然与住院治疗相比，OPAT项目可能提供短期成本节约，但也必须衡量与延长抗生素暴露和延迟确定性牙科治疗相关的风险。
