Abstract：
OBJECTIVE: To describe the experience of home antibiotic infusion therapy using elastomeric infusion pumps, administered to patients admitted to the Home Hospitalization Unit of a tertiary hospital for three years and to analyse clinical evolution and mortality.
METHODS: Retrospective observational study. The medical history of the patients included in the study was reviewed. Information was obtained on personal history, antimicrobial therapy received and clinical evolution. Statistical analysis was performed using SPSS® 19 software.
RESULTS: Eighty-one patients were included, 61.7% men, with a mean age of 73.5 ± 17.5 years. The most frequent comorbidities were diabetes mellitus (30.9%) and chronic kidney disease (28.4%). Patients received a mean of 11.9 ± 8.5 days of antibiotic treatment in an elastomeric infusion pump. The main focus of infection was respiratory (27.2%), followed by bacteremia (16%) and skin and soft tissue infections (12.3%). Of the infections, 65.4% were monomicrobial, with Pseudomonas aeruginosa being the main microorganism involved (39.6%). The most commonly used antimicrobial was piperacillin/tazobactam (33.3%). The clinical course was good in 85.2% of the patients, but the mortality rate in the 30 days following the end of treatment was 24.7%. In the univariate analysis, a history of neoplasia in the last 5 years (p = 0.01) and having received fewer days of antibiotic therapy prior to the start of outpatient antimicrobial therapy in infusion pump (p = 0.04) were associated with worse clinical outcome. Age over 80 years was associated with better outcome (p = 0.03). The diagnosis of heart failure was associated with higher mortality (p = 0.026) and patients from surgical services, with lower mortality (p = 0.047). In the multivariate analysis, the presence of neoplasia was associated with unfavorable evolution (p = 0.012) and heart failure with higher mortality (p = 0.027).
CONCLUSIONS: Outpatient antimicrobial therapy in elastomeric infusion pumps is an alternative in patients requiring prolonged intravenous treatment, and age is not a conditioning factor for inclusion in these programs. However, the presence of certain comorbidities can negatively affect the clinical course and mortality of patients.
METHODS: Retrospective observational study. The medical history of the patients included in the study was reviewed. Information was obtained on personal history, antimicrobial therapy received and clinical evolution. Statistical analysis was performed using SPSS® 19 software.
RESULTS: Eighty-one patients were included, 61.7% men, with a mean age of 73.5 ± 17.5 years. The most frequent comorbidities were diabetes mellitus (30.9%) and chronic kidney disease (28.4%). Patients received a mean of 11.9 ± 8.5 days of antibiotic treatment in an elastomeric infusion pump. The main focus of infection was respiratory (27.2%), followed by bacteremia (16%) and skin and soft tissue infections (12.3%). Of the infections, 65.4% were monomicrobial, with Pseudomonas aeruginosa being the main microorganism involved (39.6%). The most commonly used antimicrobial was piperacillin/tazobactam (33.3%). The clinical course was good in 85.2% of the patients, but the mortality rate in the 30 days following the end of treatment was 24.7%. In the univariate analysis, a history of neoplasia in the last 5 years (p = 0.01) and having received fewer days of antibiotic therapy prior to the start of outpatient antimicrobial therapy in infusion pump (p = 0.04) were associated with worse clinical outcome. Age over 80 years was associated with better outcome (p = 0.03). The diagnosis of heart failure was associated with higher mortality (p = 0.026) and patients from surgical services, with lower mortality (p = 0.047). In the multivariate analysis, the presence of neoplasia was associated with unfavorable evolution (p = 0.012) and heart failure with higher mortality (p = 0.027).
CONCLUSIONS: Outpatient antimicrobial therapy in elastomeric infusion pumps is an alternative in patients requiring prolonged intravenous treatment, and age is not a conditioning factor for inclusion in these programs. However, the presence of certain comorbidities can negatively affect the clinical course and mortality of patients.
摘要：
目的：描述使用弹性输液泵进行家庭抗生素输注治疗的经验，对三级医院家庭住院部门住院三年的患者进行治疗，并分析临床进展和死亡率。
方法：回顾性观察研究。对纳入研究的患者的病史进行了回顾。获得了关于个人历史的信息，抗菌治疗和临床进展。使用SPSS®19软件进行统计分析。
结果：包括81例患者，61.7%的男性，平均年龄为73.5±17.5岁。最常见的合并症是糖尿病（30.9％）和慢性肾脏疾病（28.4％）。患者在弹性输液泵中平均接受11.9±8.5天的抗生素治疗。感染的主要焦点是呼吸道(27.2%),其次是菌血症（16％）和皮肤和软组织感染（12.3％）。在感染中，65.4%为单抗微生物药，其中铜绿假单胞菌是主要的微生物(39.6%)。最常用的抗菌药物是哌拉西林/他唑巴坦(33.3%)。85.2%的患者临床病程良好,但治疗结束后30天的死亡率为24.7%.在单变量分析中，过去5年的肿瘤病史(p=0.01)和在输液泵门诊抗菌治疗开始前接受抗生素治疗的天数较少(p=0.04)与较差的临床结局相关.年龄超过80岁与更好的结果相关（p=0.03）。心力衰竭的诊断与较高的死亡率相关（p=0.026），死亡率较低（p=0.047）。在多变量分析中，瘤形成的存在与不良进展相关(p=0.012),心力衰竭的死亡率较高(p=0.027).
结论：弹性输液泵门诊抗菌治疗是需要长期静脉治疗的患者的替代治疗方法。年龄不是纳入这些项目的条件因素。然而,某些合并症的存在会对患者的临床病程和死亡率产生负面影响.
方法：回顾性观察研究。对纳入研究的患者的病史进行了回顾。获得了关于个人历史的信息，抗菌治疗和临床进展。使用SPSS®19软件进行统计分析。
结果：包括81例患者，61.7%的男性，平均年龄为73.5±17.5岁。最常见的合并症是糖尿病（30.9％）和慢性肾脏疾病（28.4％）。患者在弹性输液泵中平均接受11.9±8.5天的抗生素治疗。感染的主要焦点是呼吸道(27.2%),其次是菌血症（16％）和皮肤和软组织感染（12.3％）。在感染中，65.4%为单抗微生物药，其中铜绿假单胞菌是主要的微生物(39.6%)。最常用的抗菌药物是哌拉西林/他唑巴坦(33.3%)。85.2%的患者临床病程良好,但治疗结束后30天的死亡率为24.7%.在单变量分析中，过去5年的肿瘤病史(p=0.01)和在输液泵门诊抗菌治疗开始前接受抗生素治疗的天数较少(p=0.04)与较差的临床结局相关.年龄超过80岁与更好的结果相关（p=0.03）。心力衰竭的诊断与较高的死亡率相关（p=0.026），死亡率较低（p=0.047）。在多变量分析中，瘤形成的存在与不良进展相关(p=0.012),心力衰竭的死亡率较高(p=0.027).
结论：弹性输液泵门诊抗菌治疗是需要长期静脉治疗的患者的替代治疗方法。年龄不是纳入这些项目的条件因素。然而,某些合并症的存在会对患者的临床病程和死亡率产生负面影响.
