ABSTRACT
OBJECTIVE: This study aimed to evaluate the efficiency of treatment of infectious endocarditis (IE) via Self-administered Outpatient Parenteral Antimicrobial Therapy (S-OPAT) supported by a shortening hospital admission program in a hospitalization-at-home unit (HAH), including a short review of the literature. METHODS: Ambispective cohort study of 57 episodes of IE in 54 patients treated in an HAH unit between 1988 and 2014 who receive S-OPAT after prior intra-hospital clinical stabilization. Characteristics of each episode of IE, safety and efficiency of the care model, were analyzed. RESULTS: Forty-three (76%) patients were males with a median age of 61 years (SD = 16.5). A total of 37 (65%) episodes affected the native valve (42% the aortic valve). In 75%, a micro-organism was isolated, of which 88% were Gram-positive bacteria. No deaths occurred during HAH program, clinical complications appeared in 30% of episodes, only 6 patients were re-admitted to hospital although no patient died. In the 12 months' follow-up 3 cases had a recurrence. The average cost of a day stay in HAH was 174 while in traditional cardiology hospitalization was 1100. The total average cost of treatment of each episode of IE managed entirely in hospital was calculated as 54,723. Application of the S-OPAT model based on HAH meant a cost reduction of 32.72%. CONCLUSIONS: In suitably selected patients, treatment of IE based on S-OPAT supported by a shortening hospital admission care program by means of referral to a HAH unit is a safe and efficient care model which entails a significant cost saving for the public healthcare system.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Endocarditis, Bacterial/drug therapy , Home Care Services/economics , Hospitalization/economics , Outpatients , Adult , Aged , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/economics , Comorbidity , Endocarditis, Bacterial/economics , Female , Humans , Male , Middle Aged , SpainABSTRACT
The safety and efficacy of treatment of infectious endocarditis (IE) was evaluated within a program of hospital-in-home (HIH) based on self-administered outpatient parenteral antimicrobial therapy (S-OPAT). IE episodes (n=48 in 45 patients; 71% middle-aged males) were recruited into the HIH program between 1998 and 2012. Following treatment stabilization at the hospital they returned home for HIH in which a physician and/or a nurse supervised the S-OPAT. Safety and efficacy were evaluated as mortality, re-occurrence, and unexpected re-admission to hospital. Of the episodes of IE, 83.3% had comorbidities with a mean score of 2.3 on the Charlson index and 1.5 on the Profund index; 60.4% had pre-existing valve disease (58.6% having had surgical intervention); 8.3% of patients had suffered a previous IE episode; 62.5% of all episodes affected a native valve; 45.8% being mitral; 70.8% of infection derived from the community. In 75% of the episodes there was micro-organism growth, of which 83.3% were Gram positive. Overall duration of antibiotic treatment was 4.8 weeks; 60.4% of this time corresponding to HIH. Re-admission occurred in 12.5% of episodes of which 33.3% returned to HIH to complete the S-OPAT. No deaths occurred during HIH. One year after discharge, 2 patients had recurrence and 5 patients died, in 2 of whom previous IE as cause-of-death could not be excluded. In conclusion, the S-OPAT schedule of hospital-in-home is safe and efficacious in selected patients with IE.
Subject(s)
Ambulatory Care/methods , Anti-Bacterial Agents/administration & dosage , Endocarditis, Bacterial/drug therapy , Home Infusion Therapy/methods , Patient Readmission/statistics & numerical data , Administration, Intravenous , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Cohort Studies , Endocarditis/drug therapy , Female , Hospitalization , Humans , Male , Middle Aged , Prospective Studies , Retrospective Studies , Self Administration , Spain , Treatment Outcome , Young AdultSubject(s)
Amikacin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Baclofen/therapeutic use , GABA Agonists/therapeutic use , Neuromuscular Blockade/methods , Paresis/drug therapy , Aged , Amikacin/administration & dosage , Anti-Bacterial Agents/administration & dosage , Baclofen/administration & dosage , GABA Agonists/administration & dosage , Humans , Injections, Intravenous , Injections, Spinal , Lower Extremity/physiopathology , Male , Paresis/physiopathology , Upper Extremity/physiopathologyABSTRACT
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