Clinical efficacy, cost analysis and patient acceptability of outpatient parenteral antibiotic therapy (OPAT): a decade of Sheffield (UK) OPAT service
Introduction
Intravenous (IV) antimicrobials are administered increasingly in outpatient settings to treat a wide range of infections in patients who need parenteral therapy, but are well enough not to require hospital admission. Outpatient administration of IV antibiotics was first described in the USA in 1974 for patients with cystic fibrosis [1], and has become widely accepted as the standard of care in many parts of the world for patients with low-risk infections requiring long-term IV antibiotics [2], [3]. In the UK, outpatient parenteral antimicrobial therapy (OPAT) has evolved relatively slowly, but it is now becoming widespread as the benefits to patients and local healthcare systems are being recognized [4].
The Sheffield OPAT service was established in January 2006 and is one of the largest in the UK. Chapman et al reviewed the first 2 years of this service [5]. This study reviews the changes in the OPAT service over the last decade, and examines the clinical efficacy and cost savings from the use of OPAT within the UK National Health Service (NHS).
Section snippets
The OPAT service
The Sheffield OPAT service was established in January 2006, based in a regional infectious diseases unit within a large teaching hospital in South Yorkshire, England. The service grew from a two- to 16-bed (-equivalent) outpatient ‘infusion centre’ in 10 years, and the nursing team increased from 1.4 to 8.6 whole-time equivalents. The service is run by a multi–disciplinary team of infectious diseases physicians, specialist nurses and clerical support staff, with sessional inputs from
Clinical activity
Over the 10-year study period, 3812 OPAT episodes were recorded in 3004 patients. The total number of days of patient care (bed-days saved) delivered through OPAT was 49,854 (range <1 to 533 days; mean 13.1 days). The longest course of treatment was administered to a patient with multi-drug-resistant tuberculosis requiring parenteral capreomycin and meropenem. The number of episodes per year increased from 158 in 2006–2007 to 607 in 2015–2016. The total number of OPAT patient-days also
Discussion
In the UK, OPAT has evolved relatively slowly, but it is now becoming more common as the benefits to patients and local healthcare systems are being recognized [4]. Existing OPAT services have developed uniquely to meet local requirements [6], and have led to variations in practice and model of service delivery. This study reviews the OPAT service based in a regional infectious diseases unit within a large teaching hospital, and adds to the growing evidence that OPAT is safe, effective and
Conclusion
Despite the usual limitations of a retrospective database review with some missing data and potential for bias, as well as the assumptions required for the cost analysis, this large cohort study of 10 years of OPAT experience in Sheffield adds to the growing evidence that administration of IV antimicrobials to patients outside a hospital ward setting is safe, clinically efficacious, and provides substantial cost savings with high levels of patient acceptance and satisfaction. This study found
Acknowledgements
The authors wish to thank Drs Ann Chapman and Ali Omrani who were involved in the early development and growth of the Sheffield OPAT service; the dedicated OPAT specialist nurses; and the Sheffield Infectious Diseases Team.
Funding: None.
Competing interests: The University of Sheffield has received payment from the National Institute for Health and Care Excellence and Novartis for consultancy work completed by Helen Bell.
Ethical approval: Not required.
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