Community delivered outpatient parenteral antimicrobial therapy in Qatar

Abstract

Background: For some time, paramedics and nurses of the National Ambulance Service in Qatar provided outpatient parenteral antimicrobial therapy (OPAT) to patients with the support of Family Physicians. Like in many other countries of the Middle East, there is a high prevalence of antimicrobial resistance which makes treating infectious conditions challenging. Methods: This is a retrospective cohort study of patients referred to the Ambulance Service – Mobile Healthcare Service from a public hospital acute facility for OPAT over 6 months in 2015. The study's primary aim is to determine whether the OPAT service had comparable outcomes to international reports with respect to unplanned hospital visits for acute care within 30 days of OPAT referral. A secondary aim of this work is to determine the effect of body fluid culture results on that outcome by comparing subgroups within the OPAT population, and the documentation of prevalence and types of antimicrobial resistance. Results: Between the 1st of March and the 30th of August 2015, 232 OPAT referrals were received. The most common referral diagnoses are reported in Table 1. Within 30 days of OPAT referral, 24.1% - 30.7% of patients required an unplanned hospital visit. This is at the high end of the range reported internationally for OPAT services.1,2 Patients with resistant bacterial infections isolated from body fluid cultures experienced the worst outcomes. The prevalence of significant drug resistance among OPAT referrals was 28.0%, mostly extended-spectrum β-lactamase (ESBL) production. Conclusion: OPAT can be provided in the community.3 The rate of return to hospital for acute care within 30 days of OPAT referral was relatively high, however much of this can be accounted for by patients with resistant infections. They had worse outcomes than patients with non-resistant infections or those treated on an empiric basis. The prevalence of antimicrobial resistance was comparable with other recent Middle Eastern reports.