PDF(Pubmed)
Abstract：
OBJECTIVE: Outpatient parenteral antimicrobial therapy (OPAT) is a standard for antimicrobial therapy internationally. With this prospective cohort study, we aimed to assess the impact of an OPAT service as part of antimicrobial stewardship (AMS) and evaluate the safety and efficiency of the program while illuminating the financial benefit for the hospital.
METHODS: Socio-demographic data, treatment regimen and outcomes were prospectively recorded for all patients assigned to the program of the OPAT unit of the University Hospital of Zurich between November 2018 and September 2022.
RESULTS: In total, we recorded 303 OPAT assignments of which 260 resulted in effective OPAT episodes. The 260 OPAT episodes were further optimized toward the choice of antimicrobial agent (n = 18) and length of therapy (n = 6). Moreover, OPAT resulted in alteration of patient assessment and care led by AMS strategies in 247 of 260 episodes (95%). While the bed days saved per year increased consistently with time, a total of 3934 in-hospital treatment days were saved amounting to a cost saving of 9,835,000 CHF over 47 months. Adverse events were recorded in 46 cases whilst only two of these have been the reason for readmission during OPAT treatment. Clinical cure was noted in 77% (199/260) and was negatively associated with Charlson Comorbidity Index (CCI; OR per 1 unit higher 0.85 (95% CI 0.78-0.93)).
CONCLUSIONS: This study demonstrates the impact of an OPAT service in the framework of AMS as well as its benefits for the hospital whilst preserving safety and efficacy for the patient\'s parenteral antimicrobial treatment.
METHODS: Socio-demographic data, treatment regimen and outcomes were prospectively recorded for all patients assigned to the program of the OPAT unit of the University Hospital of Zurich between November 2018 and September 2022.
RESULTS: In total, we recorded 303 OPAT assignments of which 260 resulted in effective OPAT episodes. The 260 OPAT episodes were further optimized toward the choice of antimicrobial agent (n = 18) and length of therapy (n = 6). Moreover, OPAT resulted in alteration of patient assessment and care led by AMS strategies in 247 of 260 episodes (95%). While the bed days saved per year increased consistently with time, a total of 3934 in-hospital treatment days were saved amounting to a cost saving of 9,835,000 CHF over 47 months. Adverse events were recorded in 46 cases whilst only two of these have been the reason for readmission during OPAT treatment. Clinical cure was noted in 77% (199/260) and was negatively associated with Charlson Comorbidity Index (CCI; OR per 1 unit higher 0.85 (95% CI 0.78-0.93)).
CONCLUSIONS: This study demonstrates the impact of an OPAT service in the framework of AMS as well as its benefits for the hospital whilst preserving safety and efficacy for the patient\'s parenteral antimicrobial treatment.
摘要：
目的：门诊肠胃外抗菌治疗（OPAT）是国际抗菌治疗的标准。通过这项前瞻性队列研究，我们旨在评估OPAT服务作为抗菌药物管理(AMS)一部分的影响,并评估该计划的安全性和效率,同时阐明医院的财务效益.
方法：社会人口统计数据，我们前瞻性记录了2018年11月至2022年9月期间分配到苏黎世医院OPAT部门项目的所有患者的治疗方案和结局.
结果：总计，我们记录了303次OPAT分配,其中260次导致有效的OPAT发作.针对抗微生物剂(n=18)和治疗长度(n=6)的选择进一步优化了260次OPAT发作。此外，OPAT在260例发作中的247例（95％）中导致AMS策略导致的患者评估和护理改变。虽然每年节省的卧床天数随着时间的推移而持续增加，总共节省了3934天的住院治疗日，在47个月内节省了9,835,000瑞士法郎的成本。在46例中记录了不良事件，而其中只有两个是OPAT治疗期间再次入院的原因。在77%（199/260）中发现临床治愈，并且与Charlson合并症指数（CCI；每1单位OR较高0.85（95％CI0.78-0.93））呈负相关。
结论：这项研究证明了OPAT服务在AMS框架中的影响及其对医院的益处，同时保留了患者肠胃外抗菌治疗的安全性和有效性。
方法：社会人口统计数据，我们前瞻性记录了2018年11月至2022年9月期间分配到苏黎世医院OPAT部门项目的所有患者的治疗方案和结局.
结果：总计，我们记录了303次OPAT分配,其中260次导致有效的OPAT发作.针对抗微生物剂(n=18)和治疗长度(n=6)的选择进一步优化了260次OPAT发作。此外，OPAT在260例发作中的247例（95％）中导致AMS策略导致的患者评估和护理改变。虽然每年节省的卧床天数随着时间的推移而持续增加，总共节省了3934天的住院治疗日，在47个月内节省了9,835,000瑞士法郎的成本。在46例中记录了不良事件，而其中只有两个是OPAT治疗期间再次入院的原因。在77%（199/260）中发现临床治愈，并且与Charlson合并症指数（CCI；每1单位OR较高0.85（95％CI0.78-0.93））呈负相关。
结论：这项研究证明了OPAT服务在AMS框架中的影响及其对医院的益处，同时保留了患者肠胃外抗菌治疗的安全性和有效性。
