Current Status of Outpatient Parenteral Antimicrobial Therapy in Korea: Experience of a Single University-Affiliated Acute-Care Hospital
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Background: Systematic protocols for the management of outpatient parenteral antimicrobial therapy (OPAT) and information on the current status of a prescription of parenteral antibiotics for outpatients and referred patients are lacking in the Korea. This study aimed to describe the current status of OPAT at a tertiary care hospital in Korea. Materials and Methods: This was a retrospective study of outpatients and referral patients who were prescribed parenteral antibiotics from July to December 2019. We reviewed the prescribed antimicrobials, indications for antimicrobial therapy, institution administering the antimicrobial injections, and pre- and post-prescription management. Results: Of the 577 prescriptions assessed in this study, 399 (69.2%) and 178 (30.8%) were delivered using the referral and outpatient models, respectively. About 70% of OPATs were prescribed in the pulmonology, infectious diseases, orthopedics, gastroenterology, and hematology departments. Five antibiotics (ertapenem [26.0%], ceftriaxone [12.8%], kanamycin [11.8%], amikacin [10.1%], and cefazolin [8.5%]) accounted for 69.2% of the total OPATs. Urinary tract (27.3%), respiratory (20.8%), and intra-abdominal (15.9%) infections were the most frequent indications for OPAT. After prescription, there were 295 (73.9%) and 150 (84.3%) follow-up visits in the referral and outpatient models, respectively (P <0.05). Laboratory tests necessary for monitoring were fully performed for 274 (47.5%) prescriptions. Conclusion: We found that a significant number of OPATs were prescribed, follow-up visits were not performed in the case of about a quarter of prescriptions, and laboratory monitoring was not fully conducted in more than half of the cases. Therefore, it is necessary to establish an appropriate management program for OPAT. Considering the limited resources and the distribution of OPAT prescriptions, an effective strategy may be to select the frequently-used antibiotics or frequently-prescribing departments and start the program with them.
Abstract
Background: Systematic protocols for the management of outpatient parenteral antimicrobial therapy (OPAT) and information on the current status of a prescription of parenteral antibiotics for outpatients and referred patients are lacking in the Korea. This study aimed to describe the current status of OPAT at a tertiary care hospital in Korea. Materials and Methods: This was a retrospective study of outpatients and referral patients who were prescribed parenteral antibiotics from July to December 2019. We reviewed the prescribed antimicrobials, indications for antimicrobial therapy, institution administering the antimicrobial injections, and pre- and post-prescription management. Results: Of the 577 prescriptions assessed in this study, 399 (69.2%) and 178 (30.8%) were delivered using the referral and outpatient models, respectively. About 70% of OPATs were prescribed in the pulmonology, infectious diseases, orthopedics, gastroenterology, and hematology departments. Five antibiotics (ertapenem [26.0%], ceftriaxone [12.8%], kanamycin [11.8%], amikacin [10.1%], and cefazolin [8.5%]) accounted for 69.2% of the total OPATs. Urinary tract (27.3%), respiratory (20.8%), and intra-abdominal (15.9%) infections were the most frequent indications for OPAT. After prescription, there were 295 (73.9%) and 150 (84.3%) follow-up visits in the referral and outpatient models, respectively (P <0.05). Laboratory tests necessary for monitoring were fully performed for 274 (47.5%) prescriptions. Conclusion: We found that a significant number of OPATs were prescribed, follow-up visits were not performed in the case of about a quarter of prescriptions, and laboratory monitoring was not fully conducted in more than half of the cases. Therefore, it is necessary to establish an appropriate management program for OPAT. Considering the limited resources and the distribution of OPAT prescriptions, an effective strategy may be to select the frequently-used antibiotics or frequently-prescribing departments and start the program with them.
참고문헌 (25)
- Tice AD, "Practice guidelines for outpatient parenteral antimicrobial therapy. IDSA guidelines", Clin Infect Dis, 38, pp.1651~1672 (2004)
- Chapman AL, "Clinical efficacy and cost-effectiveness of outpatient parenteral antibiotic therapy(OPAT) : a UK perspective", J Antimicrob Chemother, 64, pp.1316~1324 (2009)
- Durojaiye OC, "Clinical efficacy, cost analysis and patient acceptability of outpatient parenteral antibiotic therapy(OPAT) : a decade of Sheffield(UK)OPAT service", Int J Antimicrob Agents, 51, pp.26~32 (2018)
- Wai AO, "Cost analysis of an adult outpatient parenteral antibiotic therapy(OPAT)programme. A Canadian teaching hospital and Ministry of Health perspective", Pharmacoeconomics, 18, pp.451~457 (2000)
- Halilovic J, "Managing an outpatient parenteral antibiotic therapy team : challenges and solutions", Ther Clin Risk Manag, 10, pp.459~465 (2014)
- Kim Hyung-Sook, "Development of a Roadmap for the Antimicrobial Usage Monitoring System for Medical Institutions in Korea: a Delphi Study", Infection and Chemotherapy, 54(3), pp.483~492 (2022), 대한감염학회[DOI]
- Yoon Young Kyung, "Guidelines on Implementing Antimicrobial Stewardship Programs in Korea", Infection and Chemotherapy, 53(3), pp.617~659 (2021), 대한감염학회[DOI]
- Charlson ME, "A new method of classifying prognostic comorbidity in longitudinal studies : development and validation", J Chronic Dis, 40, pp.373~383 (1987)
- Akhloufi H, "Development of operationalized intravenous to oral antibiotic switch criteria", J Antimicrob Chemother, 72, pp.543~546 (2017)
- Tsuji BT, "International Consensus Guidelines for the Optimal Use of the Polymyxins : Endorsed by the American College of Clinical Pharmacy(ACCP), European Society of Clinical Microbiology and Infectious Diseases(ESCMID), Infectious Diseases Society of America(IDSA), International Society for Anti-infective Pharmacology(ISAP), Society of Critical Care Medicine(SCCM), and Society of Infectious Diseases Pharmacists(SIDP)", Pharmacotherapy, 39, pp.10~39 (2019)
- Naranjo CA, "A method for estimating the probability of adverse drug reactions", Clin Pharmacol Ther, 30, pp.239~245 (1981)
- "International Comparisons of Health Prices and Volumes: New Findings" (2017)[URL]
- Keller SC, "Rates of and risk factors for adverse drug events in outpatient parenteral antimicrobial therapy", Clin Infect Dis, 66, pp.11~19 (2018)
- Matthews PC, "Outpatient parenteral antimicrobial therapy (OPAT): is it safe for selected patients to self-administer at home? A retrospective analysis of a large cohort over 13 years", J Antimicrob Chemother, 60, pp.356~362 (2007)
- Hatcher J, "Factors associated with successful completion of outpatient parenteral antibiotic therapy(OPAT) : A 10-year review from a large West London service", Int J Antimicrob Agents, 54, pp.207~214 (2019)
- 추은주, "Treatment of Methicillin-Resistant Staphylococcus aureus Bacteremia", Infection and Chemotherapy, 48(4), pp.267~273 (2016), 대한감염학회
- Hase R, "Review of the first comprehensive outpatient parenteral antimicrobial therapy program in a tertiary care hospital in Japan", Int J Infect Dis, 95, pp.210~215 (2020)
- Muldoon EG, "A national survey of infectious disease practitioners on their use of outpatient parenteral antimicrobial therapy(OPAT)", Infect Dis(Lond), 47, pp.39~45 (2015)
- Upton A, "Outpatient parenteral antimicrobial therapy(OPAT) : a review of experience at Auckland Hospital", N Z Med J, 117, pp.U1020~ (2004)
- Kim M, "Electronic alerts with automated consultations promote appropriate antimicrobial prescriptions", PLoS One, 11, pp.e0160551~ (2016)
- 박소미, "Impact of Intervention by an Antimicrobial Stewardship Team on Conversion from Intravenous to Oral Fluoroquinolones", Infection and Chemotherapy, 49(1), pp.31~37 (2017), 대한감염학회
- Kim SH, "Impact of expanded intervention by pharmacist-involved antimicrobial stewardship program on IV-to-PO conversion", Proceedings of the Korean Society of Health-system Pharmacists Fall conference (2019)
- Means L, "Predictors of hospital readmission in patients receiving outpatient parenteral antimicrobial therapy", Pharmacotherapy, 36, pp.934~939 (2016)
- Underwood J, "Intravenous catheter-related adverse events exceed drugrelated adverse events in outpatient parenteral antimicrobial therapy", J Antimicrob Chemother, 74, pp.787~790 (2019)