Effectiveness, safety, and feasibility of outpatient parenteral antimicrobial therapy in a resource-limited setting:...

Outpatient parenteral antimicrobial therapy (OPAT) offers a crucial method for administering intravenous/intramuscular antimicrobials outside of hospital settings, allowing patients to complete treatment safely while avoiding many hospital-acquired complications. This is a major boost or low-hanging fruit intervention in antimicrobial stewardship practices with multiple targets like decreasing hospital stays, its related complications, the economy, the burden on hospitals, etc. However, resource-constrained countries like India practices rarely OPAT in an evidence-based way.

To evaluate the effectiveness, safety, and feasibility along with barriers and facilitators of OPAT practices in resource-poor settings, with a focus on its role in antimicrobial stewardship.

This pilot longitudinal observational study included patients who met OPAT checklist criteria and were committed to post-discharge follow-up. Pre-discharge education and counselling were provided, and demographic data were recorded. Various outcome measures, including barriers and facilitators, were identified through an extensive literature review, fishbone diagram preparation, data collection and analysis, and patient feedback. All healthcare workers who were taking care of the patients discharged with OPAT were contacted with open-ended questions to get data on feasibility. The study was approved by the Institutional Ethics Committee of All India Institute of Medical Sciences, Rishikesh. We used descriptive analysis and the χ ² test to analyze data. P value < 0.05 was considered significant.

Out of 20 patients, the mean age was 37 years. The cohort comprised 13 males. OPAT was administered at home in 15 cases and at nursing homes in 5 cases, with nine patients receiving treatment from family members and 11 patients receiving care from a local nurse. The infections requiring OPAT included: Kidney-urinary tract (6 cases), gastrointestinal tract (4 cases), respiratory tract (4 cases), meningitis (3 cases), endocarditis (2 cases), and multiple visceral abscesses (1 case). Nineteen out of 20 patients achieved afebrile status. Half of the patients did not receive education, counselling, or demonstrations prior to discharge, but all patients rated the service as good/excellent. According to doctors' feedback, OPAT is highly beneficial and effective for patients when systematically implemented with daily telephonic monitoring, but faces challenges due to the lack of standardized protocols, dedicated teams, and adequate resources. The implementation of OPAT resulted in a reduction of hospitalization duration by an average of two weeks.

This pilot study proves that OPAT is safe, feasible, and efficacious by reducing two weeks of hospitalization in resource-poor settings. OPAT contributes directly to antimicrobial stewardship by reducing hospital stays and hospital-acquired complications, which is vital in combating antimicrobial resistance (AMR) and aligns with the global action plan for AMR in infection prevention and optimal antimicrobial utilization.