McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
Department of Clinical Pharmacy, Harris Health System, Houston, Texas, USA.
J Clin Pharm Ther. 2022 Feb;47(2):211-217. doi: 10.1111/jcpt.13550. Epub 2021 Oct 26.
Outpatient parenteral antibiotic therapy (OPAT) is an attractive option for patients who require parenteral antimicrobials as outpatients. Few OPAT studies have assessed the impact of IV antibiotic therapy via elastomeric continuous pumps, with most having been conducted outside the United States and few in county hospitals. The OPAT program in Harris Health system, the county hospital system of Houston, Texas, United States, has implemented a disposable elastomeric continuous infusion pump (eCIP) for self-administered intravenous antibiotics (s-OPAT) since December 2018. Our goal was to describe the clinical characteristics of patients discharged with an eCIP, as well as the safety and cost-effectiveness of this pump.
We retrospectively analysed patients discharged from Harris Health hospitals between 12/2018 and 02/2021 with s-OPAT via eCIP at home. We extracted various patient characteristics and outcomes related to OPAT.
Among 481 OPAT patients during the study period, 91 patients received s-OPAT via eCIP. A total of 1925 days of s-OPAT were administered at home, with a median duration of 12 days. Eighty-three patients (93.4%) achieved a cure from infection, six patients (6.6%) had side effects, and nine patients (9.9%) experienced 30-day hospital readmission. Twenty-two patients (24.2%) presented to the ED during s-OPAT, with 13 patients (14.3%) presenting with PICC line concerns. We estimated that s-OPAT via eCIP saved $2,360,500 to $3,503,900 compared to inpatient-only therapy.
Our study showed that patients with s-OPAT via eCIP had a high cure rate with a relatively low incidence of side effects and 30-day hospital readmission. ED visits during therapy were relatively high, which indicates the necessity of close patient monitoring via the OPAT program. eCIP appears to be a good option to facilitate an early disposition of patients in county hospitals.
门诊患者的肠外抗生素治疗（OPAT）是需要门诊肠外使用抗生素的患者的一个有吸引力的选择。很少有 OPAT 研究评估通过弹性连续泵进行静脉内抗生素治疗的影响，大多数研究在美国以外进行，少数在县医院进行。美国德克萨斯州休斯顿哈里斯卫生系统的 OPAT 项目自 2018 年 12 月以来已为自行管理静脉内抗生素（s-OPAT）实施了一次性弹性连续输注泵（eCIP）。我们的目标是描述使用 eCIP 出院患者的临床特征，以及这种泵的安全性和成本效益。
我们回顾性分析了 2018 年 12 月至 2021 年 2 月期间在哈里斯卫生系统医院出院的在家中通过 eCIP 接受 s-OPAT 的患者的各种患者特征和结局。
在研究期间的 481 名 OPAT 患者中，91 名患者通过 eCIP 接受 s-OPAT。在家中进行了总共 1925 天的 s-OPAT，中位持续时间为 12 天。83 名患者（93.4%）从感染中治愈，6 名患者（6.6%）出现副作用，9 名患者（9.9%）在 30 天内再次住院。在 s-OPAT 期间，22 名患者（24.2%）到 ED 就诊，其中 13 名患者（14.3%）出现 PICC 线问题。我们估计，与仅住院治疗相比，通过 eCIP 进行 s-OPAT 可节省 2360500 至 3503900 美元。
我们的研究表明，通过 eCIP 接受 s-OPAT 的患者治愈率高，副作用发生率相对较低，30 天内再次住院率低。治疗期间的 ED 就诊相对较高，这表明需要通过 OPAT 计划密切监测患者。eCIP 似乎是促进县医院患者早日出院的一个不错的选择。
