Tratamiento antimicrobiano domiciliario intravenoso

  • 文章类型: Journal Article
    背景:这项研究旨在提供有关使用的真实数据,功效,以及在门诊通过便携式弹性泵(pEP)进行抗生素治疗的安全性。
    方法:这项回顾性观察性队列研究于2020年1月至2023年5月在罗马的一家大型学术医院进行,意大利。通过pEP接受抗生素治疗的所有患者都包括在抗生素治疗结束后90天的随访期。主要结果是治疗反应。次要终点是可归因于给药的不良事件,血管导管,或者感染本身。
    结果:在转诊到我们的门诊肠外抗生素治疗(OPAT)单元的490名患者中,94例(19.2%)通过pEP接受抗生素治疗,并纳入最终分析。最常治疗的感染是涉及骨骼和假肢的感染,包括脊椎盘炎(n=27;28.8%)。大多数感染是由于铜绿假单胞菌(n=55;48.3%)。头孢吡肟(n=32;34.0%),哌拉西林/他唑巴坦(n=29;30.9%),头孢洛赞/他唑巴坦(n=7;7.5%),和苯唑西林(n=7;7.5%)是最常用的抗生素。感染治愈率达88.3%(n=83)。12例患者(12.8%)报告不良事件,其中一半(6.4%)与药物相关,一半(6.4%)与品系相关。
    结论:OPAT通过便携式弹性输液泵被证明是安全有效的。它还有助于降低医疗保健成本,充分尊重个性化医疗的原则。该策略已成为抗生素管理和感染控制的有希望的工具。
    BACKGROUND: This study aimed to present real-life data on the use, efficacy, and safety of administering antibiotic therapy through portable elastomeric pumps (pEP) in the outpatient setting.
    METHODS: This retrospective observational cohort study was conducted from January 2020 to May 2023 in a large academic hospital in Rome, Italy. All patients receiving antibiotic therapy via pEP were included up to a follow-up period of 90 days after the end of antibiotic therapy. The primary outcome was the treatment response. Secondary endpoints were adverse events attributable to the drug administered, the vascular catheter, or the infection itself.
    RESULTS: Of the 490 patients referred to our outpatient parenteral antibiotic therapy (OPAT) unit, 94 (19.2%) received antibiotic therapy via pEP and were included in the final analysis. The most frequently treated infections were those involving bone and prosthetics, including spondylodiscitis (n=27; 28.8%). Most infections were due to Pseudomonas aeruginosa (n=55; 48.3%). Cefepime (n=32; 34.0%), piperacillin/tazobactam (n=29; 30.9%), ceftolozane/tazobactam (n=7; 7.5%), and oxacillin (n=7; 7.5%) were the most frequently administered antibiotics. The infection cure rate reached 88.3% (n=83). 12 patients (12.8%) reported adverse events, of which half (6.4%) were drug-related and half (6.4%) were line-related.
    CONCLUSIONS: OPAT through portable elastomeric infusion pumps proved to be safe and effective. It also contributed to the reduction of healthcare costs, fully respecting the principles of personalized medicine. This strategy has emerged as a promising tool for antibiotic stewardship and infection control.
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  • 文章类型: English Abstract
    UNASSIGNED: Parenteral antibiotic treatment has been classically developed in hospitals and is considered as a hospital procedure. The development of Hospital at Home Units (HHU) has led to an increase in outpatient parenteral antibiotic therapy (OPAT) in paediatrics patients. The objective of this study is to describe our experience, as an HHU integrated within a Paediatric Department, in home antimicrobial therapy over a period of 12 years.
    METHODS: This prospective and descriptive study included every patient with a disease requiring parenteral antimicrobial therapy who was admitted to our HHU from January 2000 to December 2012.
    RESULTS: During the study there were 163 cases on OPAT. The mean age of the patients was 11.1 years, and the sample group was comprised of 33 males and 22 feamales. The main sources of the treated infections were respiratory tract (76%), catheter-related bloodstream (9.2%), and urinary tract infections (5.5%). Amikacin was the most widely used antibiotic. Almost all treatments (96.6%) were via an intravenous route. Catheter-associated complications were more common than drug-associated complications. Successful at-home treatment was observed in 90.2% of cases.
    CONCLUSIONS: OPAT is a good and safe alternative in many paediatric diseases.
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