Introduction

Outpatient parenteral antimicrobial therapy (OPAT) is safe and effective for selected patients managed within an organised clinical service. Service configurations however are evolving, patient populations are changing and new evidence is emerging which challenges traditional OPAT practice.

Areas covered

This review will discuss evolving OPAT service delivery from the traditional model of infusion centre towards non-specialist, community and remotely delivered OPAT and the challenges this represents. We consider new patient populations including those with incurable infection or infections at the end of life and difficult to reach populations including people who inject drugs. The evidence base that underpins the multi-disciplinary approach to OPAT delivery will be examined and particularly the role of the antimicrobial pharmacist and specialist nurse. Evidence for new treatment options which challenge established OPAT practice including complex oral antibiotic regimens, long acting parenteral agents and drug stability in continuous infusion antibiotics will be considered. Finally we emphasise the central importance of antimicrobial stewardship and good clinical governance which should underpin OPAT practice.

Expert opinion

Changing patient populations, service structures and team roles coupled with a growing infection management evidence base means that OPAT services and practice must evolve. Challenging traditional practice is essential to ensure best patient outcomes and cost-efficiency.

中文翻译：

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门诊胃肠外抗菌治疗的最新创新和新应用

介绍

门诊肠胃外抗菌治疗（OPAT）对于组织化临床服务中管理的部分患者是安全有效的。但是，服务配置在不断发展，患者人数在变化，新证据正在挑战传统的OPAT实践。

覆盖区域

本文将讨论从传统的输液中心模式向非专家，社区和远程交付的OPAT不断发展的OPAT服务交付的趋势，以及由此带来的挑战。我们考虑了新的患者群体，包括那些患有不可治愈的感染或生命快要结束的感染者，并且难以达到包括注射毒品者在内的人群。将研究支持OPAT交付的多学科方法的证据基础，尤其是抗菌药师和专科护士的作用。将考虑挑战现有OPAT实践的新治疗方案的证据，包括复杂的口服抗生素治疗方案，长效肠胃外药物以及连续输注抗生素中的药物稳定性。

专家意见

不断变化的患者人数，服务结构和团队角色，以及不断增长的感染管理证据基础，意味着OPAT服务和实践必须不断发展。具有挑战性的传统做法对于确保最佳患者结果和成本效益至关重要。