Department of Infectious Diseases, Nepean Hospital, Sydney, Australia.
University of Sydney Medical School, Sydney, Australia.
Infection. 2018 Jun;46(3):349-355. doi: 10.1007/s15010-018-1126-4. Epub 2018 Feb 20.
Outpatient parenteral antibiotic therapy (OPAT) is a widely accepted and safe therapeutic option for carefully selected patients. This study reviewed the practice of an OPAT service in a large Australian tertiary teaching hospital in Western Sydney over a 10-year period.
Data were retrieved from a prospectively maintained electronic database which included information on patient demographics, clinical diagnosis, microbiological identity, antimicrobial therapy, complications and readmissions. Data were analysed using descriptive statistics.
There were 3435 referrals made to the service between January 2004 and June 2014, amounting to 25,289 antibiotic days. The most frequent referral was for Skin and Soft Tissue Infections (SSTIs), 61.28%, followed by Bone and Joint Infections (BJIs), 15.30%. The most common organism identified was methicillin-sensitive Staphylococcus aureus. Readmission was uncommon (5.15%), with the highest rate of readmission noted for Cardiovascular System Infections (16.67%) followed by BJIs (10.31%). Line infection, aseptic thrombophlebitis and drug hypersensitivity or reaction were the cause of 68.55% of all complications. There was a decline in line-related complications throughout the study period.
OPAT service is in increasing demand in Australia, providing a significant relief in in-hospital days. Growth in referrals was seen not only with SSTIs and BJIs, but also a diverse range of other infective entities with limited literature in its treatment in an OPAT setting. This study highlights the need to improve data collection, develop risk stratification strategies and standardisation of OPAT services in Australia.
门诊患者的抗生素治疗（OPAT）是一种被广泛接受和安全的治疗选择，适用于经过精心挑选的患者。本研究回顾了西悉尼一家大型澳大利亚三级教学医院 10 年来 OPAT 服务的实践。
从一个前瞻性维护的电子数据库中检索数据，该数据库包括患者人口统计学、临床诊断、微生物学特征、抗生素治疗、并发症和再入院的信息。使用描述性统计数据进行数据分析。
2004 年 1 月至 2014 年 6 月期间，该服务共收到 3435 份转诊，共计 25289 个抗生素日。最常见的转诊是皮肤和软组织感染（SSTIs），占 61.28%，其次是骨和关节感染（BJIs），占 15.30%。最常见的病原体是甲氧西林敏感的金黄色葡萄球菌。再入院率较低（5.15%），心血管系统感染（16.67%）和 BJIs（10.31%）的再入院率最高。68.55%的所有并发症是由于导管相关感染、非感染性血栓性静脉炎和药物过敏或反应引起的。整个研究期间，与导管相关的并发症有所减少。
OPAT 服务在澳大利亚的需求不断增加，显著减少了住院天数。转诊的增加不仅见于 SSTIs 和 BJIs，还见于其他多种感染性疾病，而这些疾病在 OPAT 环境中的治疗方法文献有限。本研究强调了在澳大利亚需要改进数据收集、制定风险分层策略和 OPAT 服务标准化的必要性。
