title: Outpatient parenteral antimicrobial therapy and antimicrobial stewardship: challenges and checklists.
abstract: Outpatient parenteral antimicrobial therapy (OPAT) has become, for many countries, an established form of healthcare delivery. At the same time, there have been calls to ensure the prudent use of the existing antimicrobial armamentarium. For OPAT, this presents a dilemma. On one hand, stewardship principles look for the most effective agent with minimal collateral effects. In OPAT, whilst the aims of the service are similar, convenience of dosing to optimize early hospital discharge or admission avoidance may take precedence over an agent's spectrum of activity. This brief article aims to highlight the importance and explore the challenges of antimicrobial stewardship in the context of OPAT. Within the UK, the safe and effective use of antimicrobials is modelled around the IDSA/Society for Healthcare Epidemiology of America stewardship practice guidelines with local customization where appropriate. Current UK stewardship practice principles were compared with published good practice recommendations for OPAT to identify how OPAT could support the broader antimicrobial stewardship agenda. It is essential that antimicrobial stewardship teams should understand the challenges faced in the non-inpatient setting and the potential benefits/lower risks associated with avoided admission or shortened hospital stay in this population. Within its limitations, OPAT should practise stewardship principles, including optimization of intravenous to oral switch and the reporting of outcomes, healthcare-associated infections and re-admission rates. OPAT should report to the antimicrobial stewardship team. Ideally the OPAT team should be formally represented within the stewardship framework. A checklist has been proposed to aid OPAT services in ensuring they meet their stewardship agenda.
authors.affiliation: Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK mark.gilchrist@imperial.nhs.uk.
authors.forename: M
authors.initials: M
authors.lastname: Gilchrist
authors.affiliation: NHS Greater Glasgow and Clyde, Brownlee Centre, Gartnavel General Hospital, Glasgow G12 0YN, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Seaton
mesh_terms: D000553:Ambulatory Care / Q000379:methods*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D004363:Drug Utilization / Q000592:standards*; D017408:Guidelines as Topic; D006291:Health Policy; D006801:Humans; D007263:Infusions, Parenteral; D010045:Outpatients; D006113:United Kingdom
chemical_list: D000900:Anti-Bacterial Agents
keywords: ambulatory care; clinical governance; intravenous therapy