THE COMMUNITY HOSPITAL-BASED PARENTERAL ANTIMICROBIAL THERAPY (COHPAT) IN THAILAND: THE EXPERIENCE OF A MODEL TO CONTINUOUSLY TREAT BACTERIAL INFECTIONS AT KHLONGLUANG HOSPITAL

Authors

  • Teeranuch Thomnoi Department of Pharmacy, Khlongluang hospital, Pathumthani
  • Wichai Santimaleeworagun Department of Pharmacy, Faculty of Pharmacy, Silpakorn University, Sanamchandra Palace Campus, Nakhon Pathom

DOI:

https://doi.org/10.14456/tbps.2021.13

Keywords:

antibiotics, antimicrobial stewardship program, outpatient parenteral antimicrobial therapy

Abstract

The treatment of infusion antimicrobials at infusion centers out of primary hospitals to complete the duration of treatment is part of antimicrobial stewardship program (ASP). The objectives of this study were 1) to determine the type of infections and of antimicrobials in patients continuously treated with injectable antimicrobials in community hospital 2) to study the causative pathogens and the laboratory monitoring during hospitalization and 3) to evaluate the clinical outcomes. This retrospective observational study was performed at Khlongluang Hospital during March to August 2020. Fifty patients who met inclusion criteria were recruited. The lower respiratory tract (46%), urinary tract infection with bloodstream infection (12%), and intra-abdominal infection (10%) were the most common. The first three rank of antimicrobials were piperacillin/tazobactam (34.9%), meropenem (25.4%) and vancomycin (11.1%), respectively. The most causative pathogens were Klebsiella pneumoniae (29.2%) and Acinetobacter baumannii (20.8%). All patients had complete blood count monitoring and 92% of studied patients were assessed renal function. Among 50 cases, there were 37 patients discharged from community hospital with good clinical outcomes whereas the remaining cases (13 cases) had treatment failure. In conclusion, this study is the first report in Thailand revealing the effectiveness of the continuous treatment of infectious diseases with injectable antimicrobials in community hospital. This study indicated that practice guideline for antimicrobial intravenous infusion at community hospitals is need for the effectiveness and safety of antimicrobial use.

References

Thamlikitkul V. Thailand AMR Containment and Prevention Program Manual. Bangkok: Faculty of Medicine Siriraj Hospital, Mahidol University; 2015. (in Thai)

Malathum K, Rongrungruang Y, editors. The handbook of the definition and criteria of healthcare associated infection. 1st ed. Bangkok: Aksorn graphic and design publisher house; 2018. (in Thai)

Akshay BH, Anne HN. Handbook outpatient parenteral antimicrobial therapy for infectious diseases. 3rd ed. New york: Division of The Curry Rockefeller Group; 2016.

Dangpheng Y, Jareonkul K. Prevalence of carbapenem-resistant Enterobacteriaceae infection among patients attending in tertiary care hospital, bordering province of Southern Thailand. J Health Sci TSU. 2019;1(2):20-5. (in Thai)

Phumart P, Phodha T, Thamlikitkul V, Riewpaiboon A, Prakongsai P, Limwattananon S. Health and economic impacts of antimicrobial resistant infections in Thailand: a preliminary study. J Health Syst Res. 2012;6(3):352-60. (in Thai)

Norris AH, Shrestha NK, Allison GM, Keller SC, Bhavan KP, Zurlo JJ, et al. 2018 Infectious diseases society of america clinical practice guideline for the management of outpatient parenteral antimicrobial therapy. Clin Infect Dis. 2019;68(1):e1-e35.

Tice AD, Rehm SJ, Dalovisio JR, Bradley JS, Martinelli LP, Graham DR, et al. Practice guidelines for outpatient parenteral antimicrobial Therapy. Clin Infect Dis. 2004;38(12):1651-71.

Keller SC, Williams D, Gavgani M, Hirsch D, Adamovich J, Hohl D, et al. Rates of and risk factors for adverse drug events in outpatient parenteral antimicrobial therapy. Clin Infect Dis. 2018;66(1):11-9.

Suwanpimolkul G, Itiwatanagul W, Chantaramaropas M, Kitisupornpan W. OPAT. In: Surin Asawitoonthip, editor. Bangkok: Neighbour media; 2018. pp 11. (in Thai)

Lokeskrawee T, Iamsanpang S, saelao K, editors. Interfacility Transfer Operation Center. 1st ed. Nonthaburi: National Institute for Emergency Medicine; 2016. (in Thai)

Pourhoseingholi MA, Vahedi M, Rahimzadeh M. Sample size calculation in medical studies. Gastroenterol Hepatol Bed Bench. 2013;6(1):14-7.

Huck D, Ginsberg JP, Gordon SM, Nowacki AS, Rehm SJ, Shrestha NK. Association of laboratory test result availability and rehospitalizations in an outpatient parenteral antimicrobial therapy programme. J Antimicrob Chemother. 2014;69(1):228-33.

Suleyman G, Kenney R, Zervos MJ, Weinmann A. Safety and efficacy of outpatient parenteral antibiotic therapy in an academic infectious disease clinic. J Clin Pharm Ther. 2017;42(1):39-43.

Subcommittee on AMR Impact Reduction in Hospitals. Integrated AMR Management: IAM Bangkok [cited 2021 April 6]. Available from: https://amrthailand.net/uploads/ strategy/50/2.

Paul M, Shani V, Muchtar E, Kariv G, Robenshtok E, Leibovici L. Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis. Antimicrob Agents Chemother. 2010;54(11):4851-63.

Bogan C, Kaye KS, Chopra T, Hayakawa K, Pogue JM, Lephart PR, et al. Outcomes of carbapenem-resistant Enterobacteriaceae isolation: matched analysis. Am J Infect Control. 2014;42(6):612-20.

Reechaipichitkul W, Thavornpitak Y, Sutra S. Burden of adult pneumonia in Thailand: a nationwide hospital admission data 2010. J Med Assoc Thai. 2014;97(3):283-92.

Koch AM, Nilsen RM, Eriksen HM, Cox RJ, Harthug S. Mortality related to hospital-associated infections in a tertiary hospital; repeated cross-sectional studies between 2004-2011. Antimicrob Resist Infect Control. 2015;4(1):57.

Downloads

Published

2021-06-14

Issue

Section

Original Research Articles