Factores asociados a la infección por Clostridium difficile en un servicio de hospitalización domiciliaria / Factors associated to Clostridium difficile infection in a hospital-based home care service

Antecedentes y objetivo: No hay datos relativos a los factores de riesgo asociados a la infección por Clostridium difficile (ICD) en los servicios de hospitalización domiciliaria (SHD) del sistema sanitario español. Pacientes y métodos: Estudio casos-controles. Los casos fueron pacientes ingresados en un SHD entre 1 de enero de 2011 y el 31 de diciembre de 2016, que desarrollaron ICD. Los controles procedían de la misma población, con sospecha clínica de ICD y toxina CD(-). Se analizaron 82 variables. Resultados: Fueron evaluados 17 casos y 95 controles, sin diferencias por sexo, edad o comorbilidad. Se registró diarrea en el 94% y 92%, y un porcentaje de exitus del 18% y 1%, respectivamente (p=0,001). La hemiplejia/paraplejia se asoció significativamente con la ICD (odds ratio [OR] ajustada=26,4; IC 95%: 2,9-235,6; p=0,003), mientras que la enfermedad respiratoria crónica y el uso de cefalosporinas presentaron una significación marginal (OR ajustadas de 2,9 [0,8-10,3] y 3,1 [0,8-11,3], ambas p=0,08). Conclusiones: Las acciones en el SHD frente a la ICD deberían incluir una reducción en el uso de antibióticos de riesgo -según lo observado, las cefalosporinas- especialmente ante ciertas comorbilidades, como una hemiplejia/tetraplejia o una enfermedad respiratoria crónica

Background and objective: There are no data related to the risk factors associated with CDI in a Hospital-Based Home Care Service (HBHCS) of the Spanish health system. Patients and methods: Case-control study. The cases were patients admitted to the HBHCS between 01/01/2011 and 31/12/2016 who developed CDI. The controls came from the same population, with suspected CDI and CD(-) toxin. We analysed 82 variables. Results: We analysed 17 cases and 95 controls, without differences in sex, age or comorbidity. Diarrhoea was noted in 94% and 92%, and a percentage of deaths of 18% and 1%, respectively (P=.001). The presence of hemiplegia/paraplegia (adjusted odds ratio [OR]=26.4, 95% CI 2.9-235.6, P=.003) showed a significant relationship with CDI, while chronic respiratory disease and the use of cephalosporins did so with marginal significance (adjusted OR=2.9, 95% CI 0.8-10.3 and 3.1, 95% CI 0.8-11.3, respectively, both P=.08). Conclusions: Actions in the HBHCS directed towards CDI should include a reduction in the use of high-risk antibiotics -according to our results, cephalosporins- especially in patients with specific comorbidities, such as hemiplegia/tetraplegia or a chronic respiratory disease

Executive summary of outpatient parenteral antimicrobial therapy: Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases and the Spanish Domiciliary Hospitalisation Society / Resumen ejecutivo del tratamiento antimicrobiano domiciliario endovenoso: guía de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica y la Sociedad Española de Hospitalización a Domicilio

Outpatient parenteral antimicrobial therapy (OPAT) programmes make it possible to start or complete intravenous antimicrobial therapy for practically any type of infection at home, provided that patient selection is appropriate for the type of OPAT programme available. Although the clinical management of infections in the home setting is comparable in many respects to that offered in conventional hospitalization (selection of antibiotics, duration of treatment, etc.), there are many aspects that are specific to this care modality. It is essential to be aware of them so that OPAT continues to be as safe and effective as inpatient care. The objective of this clinical guideline is therefore to provide evidence- and expert-based recommendations with a view to standardizing clinical practice in this care modality and contribute to a progressive increase in the number of patients who can be cared for and receive intravenous therapy in their own homes

Los programas de tratamiento antibiótico domiciliario endovenoso (TADE) permiten iniciar o completar el tratamiento antimicrobiano por vía endovenosa de prácticamente cualquier tipo de infección en el domicilio, siempre y cuando se realice una selección del paciente acorde al tipo de programa de TADE que se dispone. Aunque hay aspectos del manejo clínico de las infecciones en el domicilio que son superponibles en la mayoría de los casos a la realizada en la hospitalización convencional (selección de la antibioterapia, duración del tratamiento, etc.), existen numerosos aspectos que son específicos de esta modalidad asistencial. Resulta imprescindible conocerlos para que el TADE siga siendo igual de eficaz y seguro que la hospitalización convencional. El objetivo de esta guía clínica es por tanto, proporcionar recomendaciones basadas en la evidencia realizadas por expertos para homogeneizar la práctica clínica de esta modalidad asistencial y contribuir a que se incremente progresivamente el número de pacientes que pueden ser atendidos y recibir tratamiento endovenoso en su propio domicilio

Executive summary of outpatient parenteral antimicrobial therapy: Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases and the Spanish Domiciliary Hospitalisation Society.

Outpatient parenteral antimicrobial therapy (OPAT) programmes make it possible to start or complete intravenous antimicrobial therapy for practically any type of infection at home, provided that patient selection is appropriate for the type of OPAT programme available. Although the clinical management of infections in the home setting is comparable in many respects to that offered in conventional hospitalization (selection of antibiotics, duration of treatment, etc.), there are many aspects that are specific to this care modality. It is essential to be aware of them so that OPAT continues to be as safe and effective as inpatient care. The objective of this clinical guideline is therefore to provide evidence- and expert-based recommendations with a view to standardizing clinical practice in this care modality and contribute to a progressive increase in the number of patients who can be cared for and receive intravenous therapy in their own homes.

Factors associated to Clostridium difficile infection in a hospital-based home care service. / Factores asociados a la infección por Clostridium difficile en un servicio de hospitalización domiciliaria.

BACKGROUND AND OBJECTIVE: There are no data related to the risk factors associated with CDI in a Hospital-Based Home Care Service (HBHCS) of the Spanish health system. PATIENTS AND METHODS: Case-control study. The cases were patients admitted to the HBHCS between 01/01/2011 and 31/12/2016 who developed CDI. The controls came from the same population, with suspected CDI and CD(-) toxin. We analysed 82 variables. RESULTS: We analysed 17 cases and 95 controls, without differences in sex, age or comorbidity. Diarrhoea was noted in 94% and 92%, and a percentage of deaths of 18% and 1%, respectively (P=.001). The presence of hemiplegia/paraplegia (adjusted odds ratio [OR]=26.4, 95% CI 2.9-235.6, P=.003) showed a significant relationship with CDI, while chronic respiratory disease and the use of cephalosporins did so with marginal significance (adjusted OR=2.9, 95% CI 0.8-10.3 and 3.1, 95% CI 0.8-11.3, respectively, both P=.08). CONCLUSIONS: Actions in the HBHCS directed towards CDI should include a reduction in the use of high-risk antibiotics -according to our results, cephalosporins- especially in patients with specific comorbidities, such as hemiplegia/tetraplegia or a chronic respiratory disease.

Efficiency of a self-administered outpatient parenteral antimicrobial therapy (s-opat) for infective endocarditis within the context of a shortened hospital admission based on hospital at home program.

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.

Early Discharge Programme on Hospital-at-Home Evaluation for Patients with Immediate Postoperative Course after Laparoscopic Colorectal Surgery.

BACKGROUND: To audit the safety of the early hospital discharge care model offered by a Hospital-at-home (HAH) unit during early postoperative follow-up of these patients, and to determine whether this care model is more efficient compared to the traditional care model. METHODS: A prospective study of 50 patients included consecutively for 1 year in an early discharge programme after laparoscopic colorectal surgery was performed. As of day 3 after surgery, if the patient met the relevant inclusion criteria they were transferred to the HAH unit. The domiciliary protocol consists of daily clinical follow-up and a series of analytical controls with the purpose of early detection of postoperative complications. If the clinical course was favourable on day 7 after the postoperative period the patient was discharged. RESULTS: A total of 66% were males, and the mean age was 60.6 years. The surgical procedure most commonly performed was sigmoidectomy. The mean stay was 5.5 days. There were no deaths during follow-up. The average estimated cost per day of stay in a HAH system was EUR 174.29 whilst the same average cost on a surgery ward stood at EUR 1,032.42. CONCLUSIONS: For patients undergoing major colorectal surgery with minimally invasive surgical technique, an early hospital discharge care programme 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.

Intravenous antimicrobial therapy in the hospital-at-home setting: data from the Spanish Outpatient Parenteral Antimicrobial Therapy Registry.

AIM: To evaluate outpatient parenteral antimicrobial therapy (OPAT) in the hospital-at-home (HaH) model, using data from a Spanish registry. PATIENTS & METHODS: We describe episodes/characteristics of patients receiving OPAT. RESULTS: Four thousand and five patients were included (mean age 66.2 years), generating 4416 HaH episodes, 4474 infections and 5088 antibiotic treatments. Most patients were from the hospital admission ward and emergency department. Respiratory, urinary and intra-abdominal infections predominated (72%). Forty-six different antimicrobials were used, including combinations of ≥ 2 drugs (20.7%). Most HaH episodes had a successful outcome (91%). CONCLUSION: Our findings are similar to those obtained previously although our study case profiles differ, suggesting that disease processes of greater severity and complexity can be treated using this healthcare model, without compromising patient safety.