Outpatient parenteral antimicrobial therapy for orthopedic infections – a successful public healthcare experience in Brazil

Authors : Priscila Rosalba Oliveira, Cassia da Silva Felix, Vladimir Cordeiro de Carvalho, Arlete Mazzini Giovani, Rosangela Suarti dos Reis, Marisa Beraldo, Edmir Peralta Albuquerque, Walter Cintra Ferreira Junior, Jorge dos Santos Silva, Ana Lucia Lei Lima

Abstract

Treatment of orthopedic infections usually requires prolonged antimicrobial therapy, ranging from 14 days up to 6 months. Nowadays, rising levels of antimicrobial resistance demands parenteral therapy for many patients. Outpatient parenteral antimicrobial therapy (OPAT) is a modality that allows treatment out of hospital in these situations. In Brazil, where a public universal healthcare system allows full coverage for all citizens, implantation and dissemination of OPAT programs would be beneficial for patients and for the system, because it would allow a better allocation of health resources. The Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da USP (IOT) started, in July 2013, a partnership with municipal health authorities in Sao Paulo, Brazil, in order to initiate an OPAT program in which patients discharged from that hospital would be able to continue antimicrobial therapy at primary care facilities. When necessary, patients could also receive their therapy at the day-hospital located at IOT. Primary care nursing and physician staff were trained about antimicrobial infusion and peripherally inserted central catheter manipulation. An OPAT specific antimicrobial protocol was designed and a special reference and counter-reference organized. As a result, 450 primary healthcare professionals were trained. In the first year of this program, 116 patients were discharged for OPAT. Chronic and acute osteomyelitis were most frequent diagnosis. Teicoplanin, ertapenem and tigecycline were the most used drugs. Duration of treatment varied from 10 to 180 days (average 101, median 42). Total sum of days in OPAT regimen was 11,698. Only 3 patients presented adverse effects. Partnership between services of different levels of complexity allowed implantation of a safe and effective public healthcare OPAT program for treatment of orthopedic infections. This program can serve as a model for developing similar strategies in other regions of Brazil and Latin America.

Keywords

Home infusion therapy; Ambulatory care facilities; Public healthcare practice; Osteomyelitis

Citation: Priscila Rosalba Oliveira, Cassia da Silva Felix, Vladimir Cordeiro de Carvalho Outpatient parenteral antimicrobial therapy for orthopedic infections – a successful public healthcare experience in Brazil doi:10.1016/j.bjid.2016.03.005

Received: 28 October 2015 Accepted: 8 March 2016 Available online: 18 April 2016

Copyright: © 2016 Elsevier Editora Ltda. This is an open access article under the CC BY-NC-ND license. (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Conclusion

The partnership between medical services of different levels of complexity allowed for the establishment of a safe and effective OPAT program for treating orthopedic infections in public health centers of São Paulo, Brazil. This program can serve as a model for developing similar strategies in other regions of Brazil and Latin America.

Conflicts of interest

The authors declare no conflicts of interest.