Outpatient parenteral antibiotic therapy (OPAT) in different countries: a comparison

Abstract

In order to assess how outpatient parenteral antibiotic therapy (OPAT) is managed in different countries, we analyzed the data collected in the USA, UK and Italy by the International OPAT Registry using an ad hoc Access/Excel Microsoft program. The analysis of data concerned 9826 patients in the USA, 981 in the UK and 620 in Italy. Differences were observed in several aspects of OPAT management such as the infections treated and the antibiotics utilized. The duration of therapy also differed: it was much longer in Italy (56.0 average days), than in the USA (22.5 days) and UK (19.9 days). Delivery model, delivery route and infusion devices show substantial differences. The present analysis shows that OPAT is carried out with substantial differences in different countries probably according to different programmes and guidelines adopted.

Introduction

The use of outpatient parenteral antibiotic therapy (OPAT) was first described in 1974 in the USA, but it is still new for many healthcare systems. Its use has rapidly grown in the USA due to the cost savings and it is estimated that more than 250,000 American patients receive OPAT each year. It is common in China and is increasing in other countries in South America and Europe [1].

OPAT has become part of routine recommendations and practice guidelines for many chronic or subacute (e.g. osteomyelitis and endocarditis) and acute infections (skin and soft tissue infections, complicated urinary tract infections) and in some cases community acquired pneumonia and completion of therapy for bacterial meningitis. Given the burden of infections requiring often protracted courses of parenteral therapy and the pressure on hospital resources (especially inpatient bed capacity), the demand for OPAT is likely to increase further due to the potential saving in hospital care costs and improvements in the allocation of limited healthcare resources [2].

OPAT programmes have now been established in many countries with considerable variations from country to country due to differences in how infectious diseases are managed worldwide and different healthcare and reimbursement systems [3], [4], [5], [6], [7], [8]. An International Registry of patients receiving OPAT was started in 1997 [9], [10], [11] in order to create, maintain and analyse a large pool of data about patients treated internationally with outpatient parenteral antibiotic therapy with the view to

• providing a broader experience base from which to draw conclusions and make decisions regarding OPAT procedures, techniques and practice;

• providing a broad basis for benchmarking and quality assurance;

• learning more about the problems associated with antimicrobial therapy;

• better understanding the clinical and microbiological outcomes associated with the range of antimicrobial therapies so as to optimise therapy for infections.

Although one of the potential functions of the registry is to analyse disease management and the impact of clinical outcome, we believe that the registry also provided descriptive data pertaining to the organisational delivery of care and the variety of country-specific approaches to managing a range of common infections [12]. In order to achieve this, we analysed the results from three key participant countries – the USA, Italy and the UK – as they represented good examples of three relatively different healthcare systems and philosophies. It is not the intention of this paper to prospectively analyse the impact of health delivery systems on outcome; it rather seeks to illustrate and explain possible differences and similarities that may be observed.