title: An outcomes analysis of outpatient parenteral antibiotic therapy (OPAT) in a large Asian cohort.
abstract: Outpatient parenteral antibiotic therapy (OPAT) facilitates early discharge, easing demands on inpatient resources and allowing patients the opportunity to restore home life. In Singapore, two large hospitals established a common prospective database in 2006. This study presents an analysis of all enrolled cases over 6 years to consider factors potentially causing adverse outcomes. In this prospective observational study, patients' first OPAT episodes, from initiation to completion, re-admission or early cessation, were recorded and analysed using Cox regression to identify factors associated with clinical deterioration leading to unplanned hospital re-admission. Of 2229 first episodes, 1874 (84.1%) completed treatment in OPAT as planned; 201 episodes (9.0%) were complicated by clinical deterioration and re-admitted. Other patients who failed to complete treatment were either re-admitted for elective procedures, experienced adverse drug reactions or peripherally inserted central catheter-related complications, or had other reasons for not completing treatment. Increased risk of clinical deterioration was associated with homecare OPAT (aHR=2.5, 95% CI 1.7-3.8; P<0.001), age >70 years (aHR=1.6, 95% CI 1.1-2.2; P=0.008) and non-private care (aHR=1.8, 95% CI 1.0-3.0; P=0.033). Diagnosis and type of antibiotic treatment were not significant risk factors for re-admission. OPAT provides intravenous antibiotics to those who would otherwise remain as hospital inpatients. In this large Asian cohort, clinical factors did not relate to the ability of patients to complete their treatment in OPAT. Criteria identified as significant warrant ongoing consideration as patients are assessed for acceptance into OPAT programmes.
authors: Department of Medicine, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 10, 119228 Singapore, Singapore.
authors: Theresa
authors: T
authors: Seetoh
authors: David C
authors: DC
authors: Lye
authors: Alex R
authors: AR
authors: Cook
authors: Sophia
authors: S
authors: Archuleta
authors: Monica
authors: M
authors: Chan
authors: Zuraidah
authors: Z
authors: Sulaiman
authors: Lihua
authors: L
authors: Zhong
authors: Ryan M
authors: RM
authors: Llorin
authors: Michelle
authors: M
authors: Balm
authors: Dale
authors: D
authors: Fisher
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D044466:Asian People; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011446:Prospective Studies; D018570:Risk Assessment; D012846:Singapore; D016896:Treatment Outcome; D028761:Withholding Treatment / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents