Department of Infection Control and Epidemiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
Department of Public Health and Primary Care, KU Leuven, University of Leuven, Herestraat 49, 3000, Leuven, Belgium.
Infection. 2019 Apr;47(2):169-181. doi: 10.1007/s15010-018-1250-1. Epub 2018 Nov 15.
This narrative review aims to describe barriers of outpatient parenteral antimicrobial therapy at home (OPAT), potentially compromising general standards of antibiotic stewardship (ABS) and facilitators of OPAT for ABS.
After a literature review, five authors determined the barriers and facilitators to discuss in this review.
Sixty-six publications were included in the narrative review and seven barriers and five facilitators are discussed in this article. The impracticability of multiple daily dosing during OPAT, the impact of real-life temperature variations, deviations of the infusion rates of elastomeric devices, access to prolonged intravenous antibiotic therapy, not administering loading doses before the initiation of extended or continuous infusions and the transmural nature of care associated with OPAT, can lead to deviations of recommended treatment regimens and sub-optimal clinical and laboratory follow-up, with a risk of inferior clinical outcomes, adverse events, drug-resistance and higher costs. On the other hand, OPAT provides access to treatments with intravenous antibiotics and simultaneously avoids prolonged hospitalization.
Implementing ABS guidelines in OPAT programs, e.g., by using a multidisciplinary team approach and facility-specific protocols for OPAT with patient selection criteria and instructions for selection, storage, preparation and administration of antibiotics, can improve appropriate antibiotic use. Additionally, further research should examine the effectiveness of these interventions on outcomes of OPAT.
本叙述性综述旨在描述门诊患者的肠外抗菌治疗（OPAT）的障碍，这些障碍可能会影响一般的抗生素管理（ABS）标准，并探讨促进 OPAT 以实现 ABS 的因素。
在文献回顾后，五位作者确定了在本次综述中需要讨论的障碍和促进因素。
本叙述性综述纳入了 66 篇文献，并讨论了其中的 7 个障碍和 5 个促进因素。OPAT 中多次每日给药的不切实际性、实际温度变化的影响、弹性装置输注率的偏差、延长静脉抗生素治疗的途径、在开始延长或连续输注前不给予负荷剂量以及与 OPAT 相关的透壁护理，可能导致推荐的治疗方案出现偏差以及临床和实验室随访效果不佳，从而导致临床结局不佳、不良事件、耐药性和更高的成本。另一方面，OPAT 提供了接受静脉抗生素治疗的途径，同时避免了长时间住院。
在 OPAT 项目中实施 ABS 指南，例如采用多学科团队方法和针对 OPAT 的特定设施方案，并制定患者选择标准以及抗生素的选择、储存、准备和管理说明，可以改善抗生素的合理使用。此外，还应进一步研究这些干预措施对 OPAT 结果的有效性。
