A program for referring adult cellulitis patients from the emergency department (ED) to outpatient parenteral antibiotic therapy (OPAT) clinics is associate with low failure rates and few adverse events, according to a prospective study.For physicians working in communities without OPAT services, I hope that this paper provides some encouragement that this is a safe and effective means to help patients without the burden of hospitalization.
Dr. Krishan Yadav of the University of Ottawa, in Canada, told Reuters Health by email. Importantly, an ED-to-OPAT program results in a high degree of patient satisfaction. OPAT is an attractive option for adults with nonpurulent skin and soft tissue infections; who require intravenous antibiotics but otherwise would not need hospitalization. There is limited information regarding ED antibiotic prescribing for such infections.
Dr. Yadav and colleagues investigate failure rates, adverse event rates, patient satisfaction; so emergency-physician rationale for selecting intravenous antibiotics in their study of 153 patients refer from the ED to the OPAT clinic over a five-month study period. Overall, 89.5% of these patients attend their clinic appointment. Five patients were admit to the hospital prior to their clinic appointment, and the remaining 11 patients were lost to follow-up.
Treating physicians provide 22 different rationales for selecting intravenous antibiotics for these patients, most commonly clinical impression (52.9%) or fail oral antibiotic therapy (41.8%); so the team reports in the American Journal of Emergency Medicine, online February 21. Some of these rationales, such as diabetes or peripheral vascular disease, warrant further study,” Dr. Yadav said.
For example, it is well establish that being diabetic makes a person more prone to infection. But is that same person less responsive to oral versus IV antibiotics. The median time to the first clinic visit was five days. so the median duration of intravenous therapy was nine days. Nearly two-thirds (63.5%) return to the ED within 14 days; but most of these visits occur for schedule intravenous doses when the home-care program could not be initiate in time for the next require dose.
There were only six OPAT treatment failures (4.4%); so all due to worsening infection. Adverse events include block or dislodge peripheral intravenous lines (15 patients, 10.9%) and antibiotic adverse events (mostly diarrhea, in 11 patients). Of the 118 patients who could be reached for telephone follow-up on day 14; so 93.2% indicate they would prefer follow-up with the OPAT clinic if they require intravenous antibiotics in the future.
One major obstacle is defining eligibility for an ED-to-OPAT-clinic program,” Dr. Yadav said. The patient must be suitable for outpatient therapy (i.e., without signs of significant systemic illness). But in addition, this approach has to be acceptable to the patient and/or their families. This is where social circumstances (e.g., can my patient travel to their OPAT-clinic appointment?) are important to consider.
Another issue is having the correct expertise,” they said. “There OPAT clinic is operate by there physician colleagues in Infectious Disease. One could argue that such a clinic may also be operate by a consultant in Internal Medicine or by an Emergency Physician. A final obstacle is funding,” Dr. Yadav said. “There are certainly costs to implementing an ED-to-OPAT-clinic program. They are currently undertaking a study to examine whether implementation of such a program leads to a reduction in healthcare costs.