Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
Intern Emerg Med. 2021 Oct;16(7):1935-1944. doi: 10.1007/s11739-021-02631-0. Epub 2021 Jan 30.
Emergency department (ED) patients with cellulitis requiring intravenous antibiotics may be eligible for outpatient parenteral antibiotic therapy (OPAT). The primary objective was to determine whether implementation of an OPAT clinic results in decreased hospitalizations and return ED visits for patients receiving OPAT. We conducted an interrupted time series study involving adults with cellulitis presenting to two EDs and treated with intravenous antibiotics. The intervention was the OPAT clinic, which involved follow up at 48-96 h with an infectious disease physician to determine the need for ongoing intravenous antibiotics (implemented January 1, 2014). The primary outcomes were hospital admission and return ED visits within 14 days. Secondary outcomes were treatment failure (admission after initiating OPAT) and adverse peripheral line or antibiotic events. We used an interrupted time series design with segmented regression analysis over one-year pre-intervention and one-year post-intervention. 1666 patients were included. At the end of the study period, there was a non-significant 12% absolute increase in hospital admissions (95% CI - 1.6 to 25.5%; p = 0.084) relative to what would have been expected in the absence of the intervention, but a significant 40.7% absolute reduction in return ED visits (95% CI 25.6-55.9%; p < 0.001). Treatment failure rates were < 2% and adverse events were < 6% in both groups. Implementation of an OPAT clinic significantly reduced return ED visits for cellulitis, but did not reduce hospital admission rates. An ED-to-OPAT clinic model is safe, and has a low rate of treatment failures.
急诊科（ED）患有蜂窝织炎并需要静脉内抗生素治疗的患者可能有资格接受门诊静脉内抗生素治疗（OPAT）。主要目标是确定是否实施 OPAT 诊所可减少接受 OPAT 治疗的患者的住院和返回 ED 就诊的次数。我们进行了一项中断时间序列研究，涉及到两家急诊科就诊并接受静脉内抗生素治疗的蜂窝织炎成人患者。干预措施是 OPAT 诊所，该诊所涉及在 48-96 小时内与传染病医生进行随访，以确定是否需要继续静脉内抗生素治疗（于 2014 年 1 月 1 日实施）。主要结局是 14 天内住院和返回 ED 就诊。次要结局是治疗失败（开始 OPAT 后入院）和不良外周线或抗生素事件。我们使用了中断时间序列设计，并在干预前一年和干预后一年进行了分段回归分析。共纳入 1666 例患者。在研究结束时，与没有干预的情况下相比，住院的绝对增加率为 12%（95%CI-1.6 至 25.5%；p=0.084），但返回 ED 就诊的绝对减少率为 40.7%（95%CI 25.6 至 55.9%；p<0.001）。两组的治疗失败率均<2%，不良事件发生率均<6%。实施 OPAT 诊所可显著减少蜂窝织炎的返回 ED 就诊次数，但不会降低住院率。ED 到 OPAT 诊所的模式是安全的，并且治疗失败率低。
