Abstract：
BACKGROUND: Outpatient parenteral antimicrobial therapy (OPAT) offers an alternative to inpatient (hospital bed-based) treatment of infections that require intravenous administration of antimicrobials. This meta-analysis aimed to summarise the evidence available from randomised controlled trials (RCTs) regarding the efficacy and safety of OPAT compared to inpatient parenteral antimicrobial therapy.
METHODS: We searched the Cochrane Library, MEDLINE, Embase, PubMed, and Web of Sciences databases for RCTs comparing outpatient versus inpatient parenteral antimicrobial therapy. We included studies without restrictions on language or publication year. Eligibility was reviewed independently by two assessors, and data extraction was cross validated. We evaluated bias risk via the Cochrane tool and determined the evidence certainty using GRADE. Meta-analysis was conducted using a random effects model. The protocol of this review was registered on PROSPERO (CRD42023460389).
RESULTS: Thirteen RCTs, involving 1,310 participants were included. We found no difference in mortality (Risk Ratio (RR) 0.54, 95% Confidence Interval (CI) 0.23 to 1.26; p = 0.93), treatment failure (RR 1.0, CI 0.59 to 1.72; p = 0.99), adverse reaction related to antimicrobials (RR 0.89, CI 0.69 to 1.15; p = 0.38), and administration device (RR 0.58, CI 0.17 to 1.98; p = 0.87) between outpatient and inpatient parenteral antimicrobial therapy. The overall body of evidence had a low level of certainty.
CONCLUSIONS: Existing evidence suggests OPAT is a safe and effective alternative to inpatient treatment. Further RCTs are warranted for a thorough comparison of inpatient and outpatient parenteral antimicrobial therapy with a high level of certainty.
METHODS: We searched the Cochrane Library, MEDLINE, Embase, PubMed, and Web of Sciences databases for RCTs comparing outpatient versus inpatient parenteral antimicrobial therapy. We included studies without restrictions on language or publication year. Eligibility was reviewed independently by two assessors, and data extraction was cross validated. We evaluated bias risk via the Cochrane tool and determined the evidence certainty using GRADE. Meta-analysis was conducted using a random effects model. The protocol of this review was registered on PROSPERO (CRD42023460389).
RESULTS: Thirteen RCTs, involving 1,310 participants were included. We found no difference in mortality (Risk Ratio (RR) 0.54, 95% Confidence Interval (CI) 0.23 to 1.26; p = 0.93), treatment failure (RR 1.0, CI 0.59 to 1.72; p = 0.99), adverse reaction related to antimicrobials (RR 0.89, CI 0.69 to 1.15; p = 0.38), and administration device (RR 0.58, CI 0.17 to 1.98; p = 0.87) between outpatient and inpatient parenteral antimicrobial therapy. The overall body of evidence had a low level of certainty.
CONCLUSIONS: Existing evidence suggests OPAT is a safe and effective alternative to inpatient treatment. Further RCTs are warranted for a thorough comparison of inpatient and outpatient parenteral antimicrobial therapy with a high level of certainty.
摘要：
背景：门诊肠胃外抗菌治疗（OPAT）为需要静脉内施用抗菌药物的感染的住院（基于医院病床）治疗提供了替代方案。这项荟萃分析旨在总结随机对照试验（RCT）中有关OPAT与住院患者肠胃外抗菌治疗相比的有效性和安全性的证据。
方法：我们搜索了Cochrane库，MEDLINE,Embase,PubMed,和WebofSciences数据库，用于比较门诊和住院患者肠外抗菌治疗。我们纳入了没有语言或出版年份限制的研究。资格由两名评估员独立审查，并对数据提取进行交叉验证。我们通过Cochrane工具评估偏倚风险，并使用GRADE确定证据确定性。采用随机效应模型进行Meta分析。本综述的方案已在PROSPERO（CRD42023460389）上注册。
结果：十三个RCT，涉及1,310名参与者。我们发现死亡率没有差异（风险比（RR）0.54，95％置信区间（CI）0.23至1.26;p=0.93），治疗失败(RR1.0，CI0.59至1.72；p=0.99)，与抗菌药物相关的不良反应（RR0.89，CI0.69至1.15；p=0.38），门诊和住院肠胃外抗菌治疗之间的给药装置（RR0.58，CI0.17至1.98；p=0.87）。总体证据的确定性较低。
结论：现有证据表明OPAT是一种安全有效的住院治疗方法。进一步的RCTs有必要对住院和门诊肠胃外抗菌治疗进行全面比较，并具有很高的确定性。
方法：我们搜索了Cochrane库，MEDLINE,Embase,PubMed,和WebofSciences数据库，用于比较门诊和住院患者肠外抗菌治疗。我们纳入了没有语言或出版年份限制的研究。资格由两名评估员独立审查，并对数据提取进行交叉验证。我们通过Cochrane工具评估偏倚风险，并使用GRADE确定证据确定性。采用随机效应模型进行Meta分析。本综述的方案已在PROSPERO（CRD42023460389）上注册。
结果：十三个RCT，涉及1,310名参与者。我们发现死亡率没有差异（风险比（RR）0.54，95％置信区间（CI）0.23至1.26;p=0.93），治疗失败(RR1.0，CI0.59至1.72；p=0.99)，与抗菌药物相关的不良反应（RR0.89，CI0.69至1.15；p=0.38），门诊和住院肠胃外抗菌治疗之间的给药装置（RR0.58，CI0.17至1.98；p=0.87）。总体证据的确定性较低。
结论：现有证据表明OPAT是一种安全有效的住院治疗方法。进一步的RCTs有必要对住院和门诊肠胃外抗菌治疗进行全面比较，并具有很高的确定性。
