Introduction

Outpatient parenteral antimicrobial therapy (OPAT) has been recognised as a useful, cost-effective and safe alternative to inpatient treatment. Nevertheless, the most common antimicrobials used are antibiotics, and there is less information about the use of antifungal therapy (AT). The aim of this study is to analyse a cohort of patients treated with AT administered via OPAT and to compare them with patients from the rest of the cohort (RC) treated with antibiotics.

Methods

Prospective observational study with post hoc (or retrospective) analysis of a cohort of patients treated in the OPAT program. We selected the patients treated with antifungals between July 2012 and December 2018. We recorded demographic and clinical data to analyse the validity of the treatment and to compare the differences between the AT and the RC.

Results

Of the 1101 patients included in the OPAT program, 24 (2.18%) were treated with AT, 12 Liposomal Amphotericin B, 6 echinocandins and 6 fluconazole. This result is similar to other cohorts. There were differences between the AT vs RC in the number of patients with neoplasia (58.3% vs 28%; p = 0.001), IC Charlson > 2 (58.3% vs 38.8; p = 0.053), duration of treatment (15 days vs 10.39 days; p = 0.001) and patients with central catheters (54.2% vs 21.7%; p = 0.0001). These differences are justified because there were more hematologic patients included in the AT group. Nevertheless, there were no differences in adverse reactions (25% vs 32.3%; p = 0.45) or re-admissions (12.5% vs 10%; p = 0.686) and OPAT with AT was successful in 21/24 patients (87.5%).

Conclusions

AT can be successfully administered in OPAT programs in selected patients, that are clinically stable and monitored by an infectious disease physician.

中文翻译：

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在 OPAT 计划中进行的抗真菌治疗对选定的患者是一种安全有效的选择。

介绍

门诊胃肠外抗菌治疗 (OPAT) 已被公认为是一种有用、经济且安全的住院治疗替代方案。然而，最常用的抗菌药物是抗生素，关于抗真菌治疗 (AT) 的使用信息较少。本研究的目的是分析一组通过 OPAT 接受 AT 治疗的患者，并将他们与来自其他接受抗生素治疗的队列 (RC) 的患者进行比较。

方法

对在 OPAT 计划中治疗的一组患者进行事后（或回顾性）分析的前瞻性观察研究。我们选择了 2012 年 7 月至 2018 年 12 月期间接受抗真菌药物治疗的患者。我们记录了人口统计学和临床​​数据以分析治疗的有效性并比较 AT 和 RC 之间的差异。

结果

在 OPAT 计划中包括的 1101 名患者中，24 名 (2.18%) 接受了 AT、12 种两性霉素 B 脂质体、6 种棘白菌素和 6 种氟康唑治疗。这个结果与其他队列相似。AT 与 RC 在肿瘤患者数量（58.3% 对 28%；p  = 0.001）、IC Charlson > 2（58.3% 对 38.8；p  = 0.053）、治疗持续时间（15 天对 10.39天；p  = 0.001）和中心导管患者（54.2% 对 21.7%；p  = 0.0001）。这些差异是合理的，因为 AT 组中包括更多的血液病患者。尽管如此，不良反应（25% 对 32.3%；p  = 0.45）或再次入院（12.5% 对 10%；p = 0.686) 并且 OPAT 与 AT 的成功率为 21/24 (87.5%)。

结论

AT 可以在选定患者的 OPAT 计划中成功实施，这些患者临床稳定并由传染病医生监测。