JAC Advance Access originally published online on November 22, 2007
Journal of Antimicrobial Chemotherapy 2008 61(1):226-227; doi:10.1093/jac/dkm449
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Letters to the Editor |
Comment on: Outpatient parenteral antibiotic therapy (OPAT): is it safe for selected patients to self-administer at home? A retrospective analysis of a large cohort over 13 years
1 Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, 119074 Singapore, Singapore 2 Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 5 Lower Kent Ridge Road, 119074 Singapore, Singapore 3 National University Hospital, 5 Lower Kent Ridge Road, 119074 Singapore, Singapore
* Corresponding author. Tel: +65-6772-5555; Fax: +65-6779-4112; E-mail: mdcfda{at}nus.edu.sg
Keywords: home intravenous therapy , H-OPAT , S-OPAT , self-administration , complications
It is with interest that we read the recent report by Matthews et al.,1 describing the success in terms of safety and practicality of the self-administration model of outpatient parenteral antibiotic therapy (S-OPAT). We have had similar experiences in our very different Asian setting.
Our service at the 1000 bed National University Hospital (NUH) in Singapore was established in late 2004 using an infusion centre model (H-OPAT). The patient demographics and disease spectra have been recently described2 and are consistent with the experience of Matthews et al., that is, a predominance of middle-aged (median 55 years) male (60%) patients with musculoskeletal infections (40%). Our antibiotic usage differed in several ways. Rather than a predominance of once-daily delivery antibiotics (ceftriaxone and teicoplanin comprised 80% of the antibiotics used), we require a greater diversity of antibiotics, particularly those with pharmacokinetics benefiting from 24 h infusion devices.3 From 369 antibiotic courses in OPAT in Singapore, 5 drugs are seen to make up 80% of total utilization; vancomycin (100), ceftriaxone (66), cefazolin (45), ertapenem (45) and ceftazidime (39) were the most frequently used, reflecting the diversity of bacteria treated and their sensitivity patterns, including methicillin-resistant Staphylococcus aureus and multidrug-resistant Gram-negative infections.
Transport complexities in this large Asian city, evidence of cost–benefit,3 and individual patient and carer requests for autonomy led us to incorporate S-OPAT into our service during 2006. To date, 53 patients have availed themselves of S-OPAT at NUH. As with the report by Matthews et al., it is now responsible for 
25% of the total bed days saved and has contributed significantly to the expansion of service (Figure 1). Our S-OPAT service is however unique in several regards. Contrary to other services described in the literatures,1,4,5 we heavily use elastomeric infusion devices for self-administration of antibiotics. We believe that this may be more convenient and potentially safer as it involves less handling by the patient or carer. Training of home caregivers occurs in the outpatient setting during the routine infusion centre attendance. This prevents a possible prolongation of inpatient length of stay. When performed by skilled nurses and accompanied by an assessment process, caregiver training was achieved with a median of 2 attendances (range 1–10). Individuals providing the infusor exchanges included spouse (25%), children (25%), self (23%) and parent (15%).
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We note that Matthews et al. showed no difference in complication rates between the S-OPAT and H-OPAT cohorts. Our outcomes are similar. The rates of drug complications (3.8% versus 2.2% per episodze), line-related complications (0% versus 2.2%), re-admission rates (13.2% versus 13.9%) and complications unrelated to OPAT (11.3% versus 9.8%) were not different between the respective S-OPAT and H-OPAT groups (Fisher's exact test).
In conclusion, our experience supports the findings of Matthews et al. and shows that the S-OPAT model applies equally to the Asian setting. When accompanied by judicious patient selection, comprehensive education, and continuous support of caregivers in the community, self-administration of antibiotics is safe and allows for greater uptake of the service. The increasing proportion of bed days saved attributable to S-OPAT and our successful use of infusion devices highlight the potential expanding role for this form of antibiotic delivery.
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 Top Funding Transparency declarationsReferences |
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This study was funded internally.
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None to declare.
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1 Matthews PC, Conlon CP, Berendt AR, et al. Outpatient parenteral antimicrobial therapy (OPAT): is it safe for selected patients to self-administer at home? A retrospective analysis of a large cohort over 13 years. J Antimicrob Chemother (2007) 60:356–62.
2 Fisher DA, Kurup A, Lye D, et al. Outpatient parental antibiotic therapy in Singapore. Int J Antimicrob Agents (2006) 28:545–50.[CrossRef][Web of Science][Medline]
3 Tice AD, Rehm SJ, Dalovisio JR, et al. Practice guidelines of outpatient parental antibiotic therapy. Clin Infect Dis (2004) 38:1651–72.[CrossRef][Web of Science][Medline]
4 Upton A, Ellis-Pegler R, Woodhouse A. Outpatient parental antibiotic therapy (OPAT): a review of experience at Auckland Hospital. N Z Med J (2004) 117:U1020.[Medline]
5
Poretz DM, Eron LJ, Goldenberg RI, et al. Intravenous antibiotic therapy in the outpatient setting. JAMA (1982) 248:336–9.
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