Outpatient parenteral antimicrobial therapy for orthopedic infections - a successful public healthcare experience in Brazil.
Treatment of orthopedic infections usually requires prolonged antimicrobial therapy, ranging from 14 days up to 6 months. Nowadays, rising levels of antimicrobial resistance demands parenteral therapy for many patients. Outpatient parenteral antimicrobial therapy (OPAT) is a modality that allows treatment out of hospital in these situations. In Brazil, where a public universal healthcare system allows full coverage for all citizens, implantation and dissemination of OPAT programs would be beneficial for patients and for the system, because it would allow a better allocation of health resources. The Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da USP (IOT) started, in July 2013, a partnership with municipal health authorities in Sao Paulo, Brazil, in order to initiate an OPAT program in which patients discharged from that hospital would be able to continue antimicrobial therapy at primary care facilities. When necessary, patients could also receive their therapy at the day-hospital located at IOT. Primary care nursing and physician staff were trained about antimicrobial infusion and peripherally inserted central catheter manipulation. An OPAT specific antimicrobial protocol was designed and a special reference and counter-reference organized. As a result, 450 primary healthcare professionals were trained. In the first year of this program, 116 patients were discharged for OPAT. Chronic and acute osteomyelitis were most frequent diagnosis. Teicoplanin, ertapenem and tigecycline were the most used drugs. Duration of treatment varied from 10 to 180 days (average 101, median 42). Total sum of days in OPAT regimen was 11,698. Only 3 patients presented adverse effects. Partnership between services of different levels of complexity allowed implantation of a safe and effective public healthcare OPAT program for treatment of orthopedic infections. This program can serve as a model for developing similar strategies in other regions of Brazil and Latin America.
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Electronic address: priscila.rosalba@hc.fm.usp.br.
Priscila Rosalba
PR
Oliveira
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
Cassia da Silva
Cda S
Felix
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
Vladimir Cordeiro de
VC
Carvalho
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
Arlete Mazzini
AM
Giovani
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
Rosangela Suarti Dos
RS
Reis
Secretaria Municipal de Saúde de São Paulo, São Paulo, SP, Brazil.
Marisa
M
Beraldo
Secretaria Municipal de Saúde de São Paulo, São Paulo, SP, Brazil.
Edmir Peralta
EP
Albuquerque
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
Walter Cintra
WC
Ferreira
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
Jorge Dos Santos
Jdos S
Silva
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
Ana Lucia Lei
AL
Lima
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000145:classification; D000890:Anti-Infective Agents; D001850:Bone Diseases, Infectious / Q000145:classification / Q000188:drug therapy; D001938:Brazil; D002648:Child; D000077727:Ertapenem; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010019:Osteomyelitis / Q000628:therapy*; D010045:Outpatients; D000078304:Tigecycline; D055815:Young Adult; D047090:beta-Lactams / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D047090:beta-Lactams; D000078304:Tigecycline; D008911:Minocycline; D000077727:Ertapenem
Ambulatory care facilities; Home infusion therapy; Osteomyelitis; Public healthcare practice