Self-administered outpatient parenteral antimicrobial therapy (S-OPAT) for infective endocarditis: A safe and effective model

• Published in: European journal of internal medicine 2015-03, Vol.26 (2), p.131-136
• Main Authors: Pajarón, Marcos, Fernández-Miera, Manuel F, Allende, Iciar, Arnaiz, Ana M, Gutiérrez-Cuadra, Manuel, Cobo-Belaustegui, Manuel, Armiñanzas, Carlos, de Berrazueta, Jose R, Fariñas, Maria C, Sanroma, Pedro
• Format: Article
• Language: English
• Subjects: Administration, Intravenous; Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory Care - methods; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Cohort Studies; Complications; Endocarditis - drug therapy; Endocarditis, Bacterial - drug therapy; Female; H-OPAT; Home Infusion Therapy - methods; Home intravenous therapy; Hospital-in-home; Hospitalization; Humans; Internal Medicine; Male; Middle Aged; Patient Readmission - statistics & numerical data; Prospective Studies; Retrospective Studies; S-OPAT; Self Administration; Spain; Treatment Outcome; Young Adult
• ISSN: 0953-6205; 1879-0828
• DOI: 10.1016/j.ejim.2015.01.001

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.