Definition of the role of OPAT in patient care

Outpatient parenteral antimicrobial therapy (OPAT) is the administration of at least 2 consecutive days of parenteral (usually intravenous) antimicrobial therapy without an overnight hospital stay. It is reserved for those patients with infection in whom parenteral antimicrobial therapy is required but who otherwise could be safely managed without hospital admission.

An OPAT service should be carefully designed and delivered to ensure safe and effective patient care. As such it is essential that a patient’s other social and healthcare needs can be managed safely in the home environment.

The aim of OPAT is to:

1. Allow earlier hospital discharge for selected patients with deep seated infections requiring parenteral therapy e.g. osteomyelitis, endocarditis and device-related infections.
2. Facilitate admission avoidance for selected patients with e.g. skin and soft tissue infections.

OPAT should not be used:

1. In patients with infections where there is a suitable safe and effective oral antimicrobial agent.
2. As an alternative to proper source control of the infection (e.g. instead of drainage of an abscess).
3. In patients with unstable, rapidly progressive or unpredictable infections.

The main advantages of OPAT to the hospital or healthcare organisation are that length of stay is reduced or avoided all together so allowing more cost-efficient use of healthcare resources. Reducing hospital stay is also associated with reduction in risk from hospital related harm in general and hospital acquired infections in particular.

Antimicrobials used within OPAT are chosen for their specific characteristics which enable their safe and effective use in a non-inpatient setting (discussed in week 2). This means that sometimes antimicrobials are chosen which would not be routinely used in the inpatient setting and they may on occasion be more expensive. These higher “drug acquisition costs” are off set by the lower costs associated with overall outpatient care. How antimicrobial choice relates to the organisation’s wider antimicrobial stewardship programme is discussed further in week 2.

Please let us know in the comments below:

• How much is OPAT used within your healthcare system?
• How aware of OPAT were you before this course?