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OPAT in Switzerland: single-center experience of a model to treat complicated infections

机译：Opat在瑞士：用于治疗复杂感染的模型的单中心体验

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Purpose Outpatient parenteral antimicrobial therapy (OPAT) programmes are established in the minority of Swiss hospitals. We aimed to study the OPAT programme at the University Hospital Basel during a 3-year period to evaluate safety and outcome. Methods All patients treated in the OPAT programme between 2015 and 2017 were included in the study. Demographic, clinical and OPAT outcome data were extracted from the hospital information system. Differences between treatment periods were analysed and risk factors for readmission and adverse events identified. Results In total, 462 patients were enrolled from 2015 to 2017. Patient numbers and total treatment days increased by 68% and 116%, respectively. Indications included many complicated infections such as bone and joint (23%) and intravascular infections (13%). Of the identified Gram-negative bacteria, 25% produced extended spectrum beta-lactamases. The percentage of antibiotics administrated with an elastomeric device increased from 11% in 2015 to 29% in 2017, whereas the use of once-daily antimicrobials (such as ceftriaxone) declined. Adverse events were rare (n = 67; 14.6%) including only two severe catheter-related events. Cure was noted in 98% of patients. 30-day unplanned readmission occurred in 46 (10.0%) patients, and intravascular infections and a higher Charlson comorbidity index were identified as independent predictors. Conclusion This study demonstrates the successful implementation of a formal OPAT programme in a Swiss tertiary care hospital. Careful selection of patients and monitoring during treatment are crucial to avoid frequent readmissions. Hence, our data call for an expansion of OPAT services in Switzerland in the near future.
机译：目的门诊肠胃外抗菌治疗（OPAT）计划是在瑞士医院的少数群体的建立。我们旨在在3年期间研究大学医院巴塞尔的OPAT计划，以评估安全和结果。方法涉及2015年至2017年间奥帕特计划中的所有患者均纳入该研究。从医院信息系统中提取了人口统计学，临床和OPAT结果数据。分析治疗期之间的差异，并确定了入伍和不良事件的危险因素。结果总计，462名患者于2015年至2017年注册。患者数量和总治疗日分别增加了68％和116％。适应症包括许多复杂的感染，如骨骼和关节（23％）和血管内感染（13％）。在确定的革兰阴性细菌中，25％产生的扩展光谱β-内酰胺酶。用弹性体装置施用的抗生素百分比从2015年的11％增加到2017年的29％，而使用一次每日抗微生物（如头脑）下降。不良事件罕见（n = 67; 14.6％），包括只有两个严重的导管相关事件。在98％的患者中指出治愈。在46名（10.0％）患者中发生了30天的大计划入院，并且血管内感染和更高的Charlson合并症指数被确定为独立预测因子。结论本研究表明，在瑞士第三节护理医院中成功实施了正式的OPAT计划。仔细选择患者和治疗期间的监测对于避免频繁的入院是至关重要的。因此，我们的数据呼吁在不久的将来扩建瑞士OPAT服务。

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