Implementing the First Outpatient Parenteral Antimicrobial Therapy (OPAT) Program to Utilize Disposable Elastomeric Pumps in the Gulf Region: Results From a Tertiary Teaching Hospital in the Kingdom of Saudi Arabia.

Ahmed Zikri,Hassan Al-Faraj,Hisham Bukhamseen,Dalia Fatih,Zainab Almusa,Jumaan Alzahrani,Nabil Kamas,Wasan Alshahoub,Arlene Beltran

doi:10.7759/cureus.20179

Abstract

ObjectivesTo describe the implementation process, safety, and efficacy outcomes, as well as cost-effectiveness, of the first outpatient parenteral antimicrobial therapy (OPAT) program to utilize disposable elastomeric pumps in the Kingdom of Saudi Arabia and the entire Gulf region.MethodsThis OPAT program was initiated in May 2018 and was administered through a multidisciplinary team that included the home medicine department, pharmacy department, nursing department, and the infectious diseases service. The device used was the Intermate® (Baxter, Deerfield, Illinois) elastomeric pump. After consultation with an infectious diseases physician, eligible patients were discharged home to complete the remainder of their antimicrobial treatment, which was self-administered via the elastomeric devices.ResultsFrom May 2018 to December 2019, 47 patients received 55 courses of OPAT via the new program. A total of 2,869 pumps were used during that period to provide 927 days of antimicrobial therapy in the home setting. Most patients completed the program successfully with no reported significant OPAT-related complications such as catheter-related infections. Four patients were re-admitted for relapse of infections and one patient was re-admitted for colistin-induced nephrotoxicity. No mortality was reported for any patient during OPAT treatment and 30 days after program completion.ConclusionsThe implementation of this novel OPAT program was safe, effective, and offered significant cost-savings to our institution. The entire process was very dynamic and was centered around proper patient selection and education as well as excellent communication between patients and the entire multidisciplinary team involved in the program. We hope that these results will encourage other institutions in the region to implement similar OPAT programs to alleviate the existing bed crisis due to the ongoing COVID-19 pandemic.

Highlights

Outpatient parenteral antimicrobial therapy (OPAT) is defined as the administration of parenteral antimicrobial therapy in at least two doses on different days without intervening hospitalization [1]
Four patients were re-admitted for relapse of infections and one patient was re-admitted for colistin-induced nephrotoxicity
The entire process was very dynamic and was centered around proper patient selection and education as well as excellent communication between patients and the entire multidisciplinary team involved in the program

Summary

Introduction

Outpatient parenteral antimicrobial therapy (OPAT) is defined as the administration of parenteral antimicrobial therapy in at least two doses on different days without intervening hospitalization [1]. Some infectious diseases such as endocarditis and osteomyelitis may require treatment with prolonged courses of intravenous antimicrobial therapy. In 1974, Rucker and colleagues described the first program to successfully use OPAT to treat chronic bronchopulmonary infections in children with cystic fibrosis [2].

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