title: Self-administered outpatient parenteral antimicrobial therapy (S-OPAT) for infective endocarditis: a safe and effective model.
abstract: The safety and efficacy of treatment of infectious endocarditis (IE) was evaluated within a program of hospital-in-home (HIH) based on self-administered outpatient parenteral antimicrobial therapy (S-OPAT). IE episodes (n=48 in 45 patients; 71% middle-aged males) were recruited into the HIH program between 1998 and 2012. Following treatment stabilization at the hospital they returned home for HIH in which a physician and/or a nurse supervised the S-OPAT. Safety and efficacy were evaluated as mortality, re-occurrence, and unexpected re-admission to hospital. Of the episodes of IE, 83.3% had comorbidities with a mean score of 2.3 on the Charlson index and 1.5 on the Profund index; 60.4% had pre-existing valve disease (58.6% having had surgical intervention); 8.3% of patients had suffered a previous IE episode; 62.5% of all episodes affected a native valve; 45.8% being mitral; 70.8% of infection derived from the community. In 75% of the episodes there was micro-organism growth, of which 83.3% were Gram positive. Overall duration of antibiotic treatment was 4.8 weeks; 60.4% of this time corresponding to HIH. Re-admission occurred in 12.5% of episodes of which 33.3% returned to HIH to complete the S-OPAT. No deaths occurred during HIH. One year after discharge, 2 patients had recurrence and 5 patients died, in 2 of whom previous IE as cause-of-death could not be excluded. In conclusion, the S-OPAT schedule of hospital-in-home is safe and efficacious in selected patients with IE.
authors.affiliation: Unidad de Hospitalización a Domicilio Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, 39008 Santander, Spain. Electronic address: mpajaron@humv.es.
authors.forename: Marcos
authors.initials: M
authors.lastname: Pajarón
authors.affiliation: Unidad de Hospitalización a Domicilio Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, 39008 Santander, Spain. Electronic address: hadfmm@humv.es.
authors.forename: Manuel F
authors.initials: MF
authors.lastname: Fernández-Miera
authors.affiliation: Dept. Medicina de Atención Primaria y Comunitaria, Area de Salud I. C/ San Fernando 15 Sta. Cruz de Bezana, 39100 Cantabria, Spain. Electronic address: iciar74@gmail.com.
authors.forename: Iciar
authors.initials: I
authors.lastname: Allende
authors.affiliation: Dept. Medicina Interna, Unidad de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, 39008 Santander, Spain. Electronic address: anarnaiz@humv.es.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Arnaiz
authors.affiliation: Dept. Medicina Interna, Unidad de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, 39008 Santander, Spain. Electronic address: magutierrez@humv.es.
authors.forename: Manuel
authors.initials: M
authors.lastname: Gutiérrez-Cuadra
authors.affiliation: Intensive Care Unit, Dept. Cardiología, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, 39008 Santander, Spain. Electronic address: manucobo@humv.es.
authors.forename: Manuel
authors.initials: M
authors.lastname: Cobo-Belaustegui
authors.affiliation: Dept. Medicina Interna, Unidad de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, 39008 Santander, Spain. Electronic address: mcfarinas@humv.es.
authors.forename: Carlos
authors.initials: C
authors.lastname: Armiñanzas
authors.affiliation: Dept. Cardiology Universidad de Cantabria, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, 39008 Santander, Spain. Electronic address: carbfj@humv.es.
authors.forename: Jose R
authors.initials: JR
authors.lastname: de Berrazueta
authors.affiliation: Dept. Medicina Interna, Unidad de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, 39008 Santander, Spain. Electronic address: carminanzas@humv.es.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Fariñas
authors.affiliation: Unidad de Hospitalización a Domicilio Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, 39008 Santander, Spain. Electronic address: hadsmp@humv.es.
authors.forename: Pedro
authors.initials: P
authors.lastname: Sanroma
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* / Q000627:therapeutic use; D015331:Cohort Studies; D004696:Endocarditis / Q000188:drug therapy; D004697:Endocarditis, Bacterial / Q000188:drug therapy*; D005260:Female; D018718:Home Infusion Therapy / Q000379:methods*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012189:Retrospective Studies; D012646:Self Administration; D013030:Spain; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Complications; H-OPAT; Home intravenous therapy; Hospital-in-home; S-OPAT; Self-administration