在选定的患者中，门诊患者治疗计划（OPAT）中给予的抗真菌治疗是一种安全有效的选择。

Antifungal treatment administered in OPAT programs is a safe and effective option in selected patients.

机构信息

Unidad Clínica de Farmacia, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio, Sevilla, Spain.

Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, Centro Superior de Investigaciones Científicas, Sevilla, Spain.

出版信息

Enferm Infecc Microbiol Clin (Engl Ed). 2020 Dec;38(10):479-484. doi: 10.1016/j.eimc.2020.01.019. Epub 2020 Mar 3.

DOI:10.1016/j.eimc.2020.01.019

PMID:32143891

Abstract

INTRODUCTION

Outpatient parenteral antimicrobial therapy (OPAT) has been recognised as a useful, cost-effective and safe alternative to inpatient treatment. Nevertheless, the most common antimicrobials used are antibiotics, and there is less information about the use of antifungal therapy (AT). The aim of this study is to analyse a cohort of patients treated with AT administered via OPAT and to compare them with patients from the rest of the cohort (RC) treated with antibiotics.

METHODS

Prospective observational study with post hoc (or retrospective) analysis of a cohort of patients treated in the OPAT program. We selected the patients treated with antifungals between July 2012 and December 2018. We recorded demographic and clinical data to analyse the validity of the treatment and to compare the differences between the AT and the RC.

RESULTS

Of the 1101 patients included in the OPAT program, 24 (2.18%) were treated with AT, 12 Liposomal Amphotericin B, 6 echinocandins and 6 fluconazole. This result is similar to other cohorts. There were differences between the AT vs RC in the number of patients with neoplasia (58.3% vs 28%; p=0.001), IC Charlson>2 (58.3% vs 38.8; p=0.053), duration of treatment (15 days vs 10.39 days; p=0.001) and patients with central catheters (54.2% vs 21.7%; p=0.0001). These differences are justified because there were more hematologic patients included in the AT group. Nevertheless, there were no differences in adverse reactions (25% vs 32.3%; p=0.45) or re-admissions (12.5% vs 10%; p=0.686) and OPAT with AT was successful in 21/24 patients (87.5%).

CONCLUSIONS

AT can be successfully administered in OPAT programs in selected patients, that are clinically stable and monitored by an infectious disease physician.

摘要

简介

门诊患者的肠外抗菌治疗（OPAT）已被认为是一种有用、具有成本效益和安全的替代住院治疗的方法。然而，最常用的抗菌药物是抗生素，而关于抗真菌治疗（AT）的信息较少。本研究的目的是分析一组接受 OPAT 下 AT 治疗的患者，并将他们与来自其余接受抗生素治疗的队列（RC）的患者进行比较。

方法

对 2012 年 7 月至 2018 年 12 月期间接受 OPAT 治疗的患者进行前瞻性观察性研究，并进行事后（或回顾性）分析。我们选择了接受抗真菌药物治疗的患者。记录人口统计学和临床数据，以分析治疗的有效性，并比较 AT 与 RC 之间的差异。

结果

在纳入 OPAT 计划的 1101 名患者中，有 24 名（2.18%）接受 AT 治疗，其中 12 名患者接受脂质体两性霉素 B 治疗，6 名患者接受棘白菌素类药物治疗，6 名患者接受氟康唑治疗。这一结果与其他队列相似。在患有肿瘤的患者数量（58.3%比 28%；p=0.001）、IC Charlson 评分>2（58.3%比 38.8%；p=0.053）、治疗持续时间（15 天比 10.39 天；p=0.001）和中央导管患者数量（54.2%比 21.7%；p=0.0001）方面，AT 组与 RC 组存在差异。这些差异是合理的，因为 AT 组中包含了更多的血液学患者。然而，在不良反应（25%比 32.3%；p=0.45）或再入院（12.5%比 10%；p=0.686）方面没有差异，并且在 24 名接受 AT 治疗的患者中，有 21 名（87.5%）的 OPAT 治疗是成功的。