Ester Steffens1,2, Charlotte Quintens3, Inge Derdelinckx4,5, Willy E Peetermans4,5, Johan Van Eldere5,6, Isabel Spriet3, Annette Schuermans7,8. 1. Department of Infection Control and Epidemiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. ester.steffens@uzleuven.be. 2. Department of Public Health and Primary Care, KU Leuven, University of Leuven, Herestraat 49, 3000, Leuven, Belgium. ester.steffens@uzleuven.be. 3. Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, University Hospitals Leuven, University of Leuven, Herestraat 49, 3000, Leuven, Belgium. 4. Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium. 5. Department of Microbiology and Immunology, KU Leuven, University Hospitals Leuven, University of Leuven, Herestraat 49, 3000, Leuven, Belgium. 6. Department of Quality Improvement, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. 7. Department of Infection Control and Epidemiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. 8. Department of Public Health and Primary Care, KU Leuven, University of Leuven, Herestraat 49, 3000, Leuven, Belgium.
Abstract
PURPOSE: This narrative review aims to describe barriers of outpatient parenteral antimicrobial therapy at home (OPAT), potentially compromising general standards of antibiotic stewardship (ABS) and facilitators of OPAT for ABS. METHODS: After a literature review, five authors determined the barriers and facilitators to discuss in this review. RESULTS: Sixty-six publications were included in the narrative review and seven barriers and five facilitators are discussed in this article. The impracticability of multiple daily dosing during OPAT, the impact of real-life temperature variations, deviations of the infusion rates of elastomeric devices, access to prolonged intravenous antibiotic therapy, not administering loading doses before the initiation of extended or continuous infusions and the transmural nature of care associated with OPAT, can lead to deviations of recommended treatment regimens and sub-optimal clinical and laboratory follow-up, with a risk of inferior clinical outcomes, adverse events, drug-resistance and higher costs. On the other hand, OPAT provides access to treatments with intravenous antibiotics and simultaneously avoids prolonged hospitalization. CONCLUSION: Implementing ABS guidelines in OPAT programs, e.g., by using a multidisciplinary team approach and facility-specific protocols for OPAT with patient selection criteria and instructions for selection, storage, preparation and administration of antibiotics, can improve appropriate antibiotic use. Additionally, further research should examine the effectiveness of these interventions on outcomes of OPAT.
PURPOSE: This narrative review aims to describe barriers of outpatient parenteral antimicrobial therapy at home (OPAT), potentially compromising general standards of antibiotic stewardship (ABS) and facilitators of OPAT for ABS. METHODS: After a literature review, five authors determined the barriers and facilitators to discuss in this review. RESULTS: Sixty-six publications were included in the narrative review and seven barriers and five facilitators are discussed in this article. The impracticability of multiple daily dosing during OPAT, the impact of real-life temperature variations, deviations of the infusion rates of elastomeric devices, access to prolonged intravenous antibiotic therapy, not administering loading doses before the initiation of extended or continuous infusions and the transmural nature of care associated with OPAT, can lead to deviations of recommended treatment regimens and sub-optimal clinical and laboratory follow-up, with a risk of inferior clinical outcomes, adverse events, drug-resistance and higher costs. On the other hand, OPAT provides access to treatments with intravenous antibiotics and simultaneously avoids prolonged hospitalization. CONCLUSION: Implementing ABS guidelines in OPAT programs, e.g., by using a multidisciplinary team approach and facility-specific protocols for OPAT with patient selection criteria and instructions for selection, storage, preparation and administration of antibiotics, can improve appropriate antibiotic use. Additionally, further research should examine the effectiveness of these interventions on outcomes of OPAT.
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