Section of Infectious Disease, Department of Medicine, Boston Medical Center, Boston, MA (RJ, DC, MF), Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA (RJ, HR, AYW).
J Addict Med. 2022;16(2):e70-e72. doi: 10.1097/ADM.0000000000000856.
Outpatient parenteral antibiotic therapy (OPAT) refers to the monitored provision of intravenous antibiotics for complicated infections outside of a hospital setting, typically in a rehabilitation facility, an infusion center, or the home. Home-based OPAT allows for safe completion of prolonged courses of therapy while decreasing costs to the healthcare system, minimizing the risk of hospital-related infectious exposures for patients, and permitting patients to recover in a familiar environment. Amidst the COVID-19 pandemic, during which nursing facilities have been at the center of many outbreaks of the SARS-CoV-2 virus, completion of antimicrobial therapy in the home is an even more appealing option. Persons who inject drugs (PWID) frequently present with infectious complications of their injection drug use which require long courses of parenteral therapy. However, these individuals are frequently excluded from home-based OPAT on the basis of their addiction history. This commentary describes perceived challenges to establishing home-based OPAT for PWID, discusses ways in which this is discriminatory and unsupported by available data, highlights ways in which the COVID-19 pandemic has accentuated inequities in care, and proposes a multidisciplinary approach championed by Addiction specialists to increasing implementation of OPAT for appropriate patients with substance use disorders.
门诊患者的肠外抗生素治疗（OPAT）是指在医院环境外，对复杂感染患者进行静脉抗生素治疗，并进行监测，通常在康复机构、输液中心或家中进行。家庭为基础的 OPAT 允许安全地完成长期的治疗过程，同时降低医疗系统的成本，最大限度地减少患者在医院相关感染暴露的风险，并允许患者在熟悉的环境中康复。在 COVID-19 大流行期间，护理机构一直是 SARS-CoV-2 病毒许多爆发的中心，在家庭中完成抗菌治疗是一个更有吸引力的选择。注射毒品者（PWID）经常因注射毒品使用而出现感染并发症，需要长期的肠外治疗。然而，这些人经常因为他们的成瘾史而被排除在家庭为基础的 OPAT 之外。本评论描述了为 PWID 建立家庭为基础的 OPAT 所面临的挑战，讨论了这种做法的歧视性和缺乏现有数据支持的情况，强调了 COVID-19 大流行如何加剧了护理方面的不平等，并提出了一种由成瘾专家倡导的多学科方法，以增加对适当的物质使用障碍患者进行 OPAT 的实施。
