JAC Antimicrob Resist. 2020 Aug 6;2(3):dlaa052. doi: 10.1093/jacamr/dlaa052. eCollection 2020 Sep.
OBJECTIVES: A review of patients requiring lifelong antibiotics to control, rather than cure, infection was performed ['palliative outpatient parenteral antibiotic therapy (OPAT)']. This was to evaluate emerging themes and complications. The aim was to aid in the management of such patients.
METHODS: A retrospective review of the OPAT database over 5 years (2013-17) was performed. Of the 1438 patients, 9 were deemed to have received palliative OPAT.
RESULTS: The palliative cohort represented 0.6% of the total number of patients on OPAT and 8.6% of the bed days saved. Patients fell into two main groups: those with multiple comorbidities that precluded surgical management and those with a terminal condition. Both groups received IV antibiotics with no clear endpoint. The themes to emerge were: patients often had multiple comorbidities with a high operative risk to control the source of infection; a trial of no or oral antibiotics led to resurgence of the infection; vascular patients appeared to tolerate long-term antibiotics well; and conversely, antibiotic side effects were a significant issue in others. Patients with incurable cancer and a coincident infection can be given additional quality of life with the judicious use of appropriate therapy.
CONCLUSIONS: There are significant issues surrounding antimicrobial stewardship in the palliative OPAT group that should be considered. Excellent communication is required to deal with these often very complicated patients. There are considerable gains to be made both for patients and the number of bed days saved. The small number of patients accounted for a disproportionate number of bed days saved.