Department of Pharmacy, Oregon Health & Science University, Portland, OR, USA.
School of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, USA.
Ann Pharmacother. 2023 Feb;57(2):156-162. doi: 10.1177/10600280221101105. Epub 2022 Jun 3.
The OVIVA trial suggests oral antibiotics are an alternative to intravenous antibiotics to treat bone and joint infections (BJI). A shift in practice to treatment with oral antibiotics would eliminate the need for central vascular access, improve patient satisfaction, and reduce overall healthcare costs.
The primary objective was to identify the proportion of patients treated for BJIs with outpatient parenteral antimicrobial therapy (OPAT) who would have qualified for oral antibiotics based on microbiological data. The secondary objective was to conduct a cost-analysis to estimate potential cost-savings had eligible patients been treated with oral antibiotics.
This was a single-center, retrospective study of adult patients in the United States treated with intravenous antibiotics for BJIs from January 2018 to April 2020. Inclusion and exclusion criteria matched the OVIVA trial. Patients with bacteremia, endocarditis, or other high-risk features were excluded.
281 patients met the inclusion criteria. Most had prosthetic joint infections (56%). Infections caused by coagulase-negative staphylococci (25%) were most common, followed by (23%) and polymicrobial infections (22%). 69 (25%) patients required a switch during their OPAT course to an alternate antibiotic agent. Thirteen patients (5%) experienced vascular access complications, and 6 patients (2%) developed infections. Oral therapy could have resulted in an estimated average savings per patient of $3,270.69 USD.
Most patients treated with OPAT for BJIs were candidates for oral antibiotics. A change in practice would result in cost-savings to the U.S. healthcare system.
OVIVA 试验表明，口服抗生素可替代静脉内抗生素治疗骨和关节感染（BJI）。将治疗方法改为口服抗生素将消除中心血管通路的需求，提高患者满意度，并降低整体医疗保健成本。
主要目的是确定根据微生物学数据，接受 BJIs 门诊患者静脉内抗生素治疗（OPAT）的患者中有多少比例符合口服抗生素治疗的条件。次要目的是进行成本分析，以估算符合条件的患者接受口服抗生素治疗时可能节省的潜在成本。
这是一项在美国进行的单中心、回顾性研究，纳入了 2018 年 1 月至 2020 年 4 月期间接受静脉内抗生素治疗的 BJIs 成年患者。纳入和排除标准与 OVIVA 试验匹配。排除了菌血症、心内膜炎或其他高危特征的患者。
281 名患者符合纳入标准。大多数患者（56%）患有假体关节感染。最常见的感染是凝固酶阴性葡萄球菌引起的感染（25%），其次是金黄色葡萄球菌引起的感染（23%）和混合感染（22%）。69 名（25%）患者在 OPAT 治疗过程中需要更换另一种抗生素。13 名患者（5%）发生血管通路并发症，6 名患者（2%）发生感染。口服治疗可能使每位患者的平均节省费用估计为 3270.69 美元。
接受 OPAT 治疗 BJIs 的大多数患者都是口服抗生素的候选者。治疗方法的改变将为美国的医疗保健系统节省成本。
