7th May 2020

BSAC has responded to NHSE request for information on the deployment of OPAT services during COVID.

Outpatient parenteral antimicrobial therapy (OPAT) has been shown to be safe and effective for a wide range of infections in adults and children.1 In 2019, the initiative published revised UK OPAT good practice recommendations (GPRs) for adults and children across a range of healthcare settings.1 Data held on file from the BSAC OPAT National Outcomes Registry noted that skin and soft tissue infections, bronchiectasis, urinary tract infections, and bone and joint infections were common diagnosis treated.

During the COVID pandemic, OPAT services across the UK are continuing to provide a mechanism to allow treatment to be delivered in patient’s own homes and avoid hospital admission/limit hospital exposure where appropriate.

OPAT centres are adapting to the pandemic by offering selected patients monitoring via telemedicine and the use of novel weekly or oral antimicrobials in conjunction with principles outlined in the GPRs around antimicrobial stewardship and clinical governance. Expansion of direct community referral to OPAT for skin and soft tissue infections and multidrug resistant urinary tract infections also avoids initial inpatient assessment.

Adults examples of such practice includes:

Skin and Soft Tissue Infections (SSTIs) – (i) For those with SSTI requiring IV therapy who are lower risk and ambulant: Promotion of OPAT with daily attendance to optimise IV to oral switch (ii) For vulnerable/shielded patients not suitable for daily attendance: After a specialist OPAT review consider using Linezolid for 5-7 days or if contra-indicated due to drug interactions then a single dose of Dalbavancin 1g with a virtual review at day 3 to ensure improvement.

Bronchiectasis Infections (no oral options) – Virtual OPAT appointments in conjunction with patient’s respiratory team. Patient relative attends hospital for self-administer training e.g. Cefalosporin/Carbapenem. Patient attends hospital once for bloods and vascular device placement.

Urinary Tract Infections – Direct referral of patient with MDRUTI from the community. For specialist OPAT/Infection specialist review to optimise review of need for antibiotics, use of oral therapies when possible and judicious use of OP IV therapy.

A similar approach needs to be adopted for children. A significant proportion of children with common infections continue to be admitted to hospital for IV antimicrobials when they could either be safely managed at home with oral antibiotics or be ambulated on IV therapy.2,3 Embedding the principles of antimicrobial stewardship and OPAT into the management of children with common infections can be a hugely effective strategy in minimising exposure to hospital for this cohort of patients. National guidance on first line treatment of common infections is available here.

References:

1. Chapman A et al. Updated good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) in adults and children in the UK, JAC-Antimicrobial Resistance, Volume 1, Issue 2, September 2019.
2. Tanner E et al. Improving paediatric antimicrobial stewardship in hospital-based settings: why, where and how? JAC-Antimicrobial Resistance, Volume 2, Issue 1, March 2020. https://academic.oup.com/jacamr/article/2/1/dlaa011/5805095

3. McMullan BJ et al. Antibiotic duration and timing of the switch from intravenous to oral route for bacterial infections in children: systematic review and guidelines. Lancet Infect Dis. 2016 Aug;16(8): e139-52.

4. NICE Summary of antimicrobial prescribing guidance – managing common infections. March 2020 https://www.nice.org.uk/Media/Default/About/what-we-do/NICEguidance/antimicrobial%20guidance/summary-antimicrobial-prescribing-guidance.pdf

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