Clinical effectiveness of flucloxacillin delivery using an elastomeric device for outpatient parenteral antimicrobial therapy
There has been a surging interest in using elastomeric infusion devices to deliver outpatient parenteral antimicrobial therapy (OPAT), which is more cost-effective than standard antibiotic administration, which requires multiple daily home visits. This has been particularly important since the outbreak of the coronavirus pandemic, because reducing patient contact can also help to minimise transmission of COVID-19 to outpatients who are at a high risk of COVID-19-triggered complications. In this retrospective study, the clinical effectiveness of intravenous (IV) infusion of flucloxacillin using an elastomeric device was explored in a convenience sample of patients. Patients with three primary infective diagnoses—bloodstream infection, non-vertebral osteomyelitis and vertebral osteomyelitis—were included in the analyses. In non-vertebral osteomyelitis patients, Accufuser antibiotic infusion shortened the course of OPAT care relative to standard antibiotic administration (p<.05). In contrast, in vertebral osteomyelitis patients, it prolonged the course of OPAT care relative to standard administration (p<.05). In patients with bloodstream infections, no significant difference was found between the treatment modes (p=.93). Thus, the clinical effectiveness of Accufuser antibiotic infusion varies among patients with different infective diagnoses, and there seems to be a complex relationship between the method of antibiotic delivery and the patient's condition.
Outpatient parenteral antimicrobial therapy (OPAT) involves intravenous (IV) administration of antibiotics to patients whose treatments can be safely managed at their own homes (Paladino and Poretz, 2010; Seaton and Barr, 2013). This usually involves nurses visiting patients' homes on a regular basis. Multiple tasks are performed during each visit, including delivery of antibiotics, collection of blood samples and provision of care for their IV devices, as well as clinical assessment of their progress.
The number of daily visits required varies among OPAT patients, depending on their conditions as well as the type of antimicrobial treatment. Certain antimicrobial treatments, such as piperacillin/tazobactam (tazocin) and flucloxacillin, require more doses per day and, hence, more daily visits than broad-spectrum (i.e. target-nonspecific) antibiotic treatments, such as ceftriaxone, which requires only one dose per day. For example, the standard administration of IV tazocin involves three doses administered at regular intervals every day, requiring multiple home visits and putting a considerable amount of pressure on the limited resources of local OPAT teams. This is particularly a concern for antimicrobial treatments that require even more frequent doses per day. In the authors' experience, as an example, none of the community teams in Oxfordshire, England, have the capacity to provide out-of-hours IV flucloxacillin administration at patients' homes, which involves four doses at regular intervals per day. Hence, patients requiring flucloxacillin either stay in hospitals for IV treatments or receive broad-spectrum antibiotic treatments that require fewer doses per day. These alternative options are suboptimal for the patient.
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