ABSTRACT

Introduction

Outpatient parenteral antimicrobial therapy (OPAT) is safe and effective for selected patients managed within an organized 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 center toward nonspecialist, 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 emphasize 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。

摘要

介绍

门诊胃肠外抗菌治疗 (OPAT) 对于在有组织的临床服务中管理的特定患者是安全有效的。然而，服务配置在不断发展，患者群体也在不断变化，新的证据不断涌现，这对传统的 OPAT 实践提出了挑战。

覆盖区域

本综述将讨论 OPAT 服务交付从传统的输液中心模式向非专科医生、社区和远程交付 OPAT 的演变及其所代表的挑战。我们考虑新的患者群体，包括那些患有无法治愈的感染或临终感染以及难以接触到的人群，包括注射吸毒者。将检查支持 OPAT 实施多学科方法的证据基础，特别是抗菌药剂师和专科护士的作用。将考虑挑战既定的 OPAT 实践的新治疗方案的证据，包括复杂的口服抗生素方案、长效胃肠外药物和连续输注抗生素的药物稳定性。

专家意见

不断变化的患者群体、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 服务和实践必须发展。挑战传统做法对于确保最佳患者治疗效果和成本效益至关重要。