Purpose: Outpatient parenteral antimicrobial therapy (OPAT) is a standard for antimicrobial therapy internationally. With this prospective cohort study, we aimed to assess the impact of an OPAT service as part of antimicrobial stewardship (AMS) and evaluate the safety and efficiency of the program while illuminating the financial benefit for the hospital. Methods: Socio-demographic data, treatment regimen and outcomes were prospectively recorded for all patients assigned to the program of the OPAT unit of the University Hospital of Zurich between November 2018 and September 2022. Results: In total, we recorded 303 OPAT assignments of which 260 resulted in effective OPAT episodes. The 260 OPAT episodes were further optimized toward the choice of antimicrobial agent (n = 18) and length of therapy (n = 6). Moreover, OPAT resulted in alteration of patient assessment and care led by AMS strategies in 247 of 260 episodes (95%). While the bed days saved per year increased consistently with time, a total of 3934 in-hospital treatment days were saved amounting to a cost saving of 9,835,000 CHF over 47 months. Adverse events were recorded in 46 cases whilst only two of these have been the reason for readmission during OPAT treatment. Clinical cure was noted in 77% (199/260) and was negatively associated with Charlson Comorbidity Index (CCI; OR per 1 unit higher 0.85 (95% CI 0.78–0.93)). Conclusion: This study demonstrates the impact of an OPAT service in the framework of AMS as well as its benefits for the hospital whilst preserving safety and efficacy for the patient’s parenteral antimicrobial treatment.

Objectives To evaluate the improvements in the mean Short Form-36 (SF-36) score (95% CI) from predischarge to postdischarge among prospective participants of a Swiss Outpatient Parenteral Antimicrobial Therapy (OPAT) programme using Patient Reported Outcomes. Design Prospective cohort study. Setting A public tertiary care hospital in Switzerland. Participants Patients enrolled in the University Hospital Zurich’s OPAT programme between October 2020 and September 2022. They were interviewed predischarge (interview 1) and 7–14 days postdischarge (interview 2) using a shortened, four-domain version of the validated SF-36) questionnaire, complemented by four additional questions gauging patient satisfaction. Co-primary outcomes The primary outcomes were the scores in four domains of the SF-36 questionnaire. Results 33 patients participated in the study. Univariate analysis revealed substantial improvement in three of the four SF-36 domains. Specifically, participants reported improvements in the mean SF-36 score (95% CI) from interviews 1 to 2 for ‘emotional role’ (24.2 (5.0–43.5)), ‘social functioning’ (22.0 (95%CI 10.8 to 33.2)) and ‘emotional well-being’ (11.9 (95%CI 5.6 to 18.2)). Furthermore, 97% of patients would recommend OPAT to others. Conclusion Patients experienced significant improvements in Health-Related Quality of Life (HRQoL) while enrolled in OPAT and the programme yields high patient satisfaction. Hospitals considering new OPAT programmes should include both patient satisfaction and HRQoL impact in their argument repertoire for the introduction of OPAT.

Introduction: Potentially inappropriate medications (PIMs) are medications with an unfavourable risk–benefit profile for patients aged ≥ 65 years. Currently, several screening tools are available and are used in clinical practice to identify PIMs. Aim: Our objective was to systematically synthesize the available evidence on the association between potentially inappropriate medications (PIMs), as identified by various screening tools including STOPP/START and the Beers Criteria, and the outcomes of rehospitalization and mortality within three months in older patients. Method: Adhering to Cochrane standards, we conducted a systematic review and meta-analysis to investigate the outcomes of patients aged 65 years and older, comparing those with at least one PIM identified by any explicit screening tool to those without PIMs. Primary outcomes were readmission and/or death within three months. The databases of Embase, MEDLINE, and CENTRAL were searched for retrospective as well as prospective observational studies published between 1991 and May 17 2024. The risk of bias was assessed for all included studies. Results: In total, 1,642 studies were identified through the systematic search. Nine observational studies were included in this review. Our analysis revealed a statistically significant association between the overall presence of PIMs and rehospitalisation; odds ratio (OR) 1.47 [95% confidence interval (CI) 1.02 to 2.13, p = 0.045]. While stratification according to STOPP/START criteria yielded a statistically significant OR of 1.84 [CI 1.08 to 3.12, p = 0.024; n = 5], no statistically significant difference was seen according to Beers list [OR 1.25, CI 0.86 to 1.81, p = 0.235; n = 5]. Furthermore, no significant association was found between PIMs and mortality in either the overall analysis or the stratification according to the Beers and STOPP/START criteria. The risk of bias in the included studies was moderate to serious, and the certainty of evidence was very low. Conclusion: The use of PIM screening tools during medication evaluations may reduce the risk of rehospitalisation and potentially lower mortality in older patients. However, further studies are warranted to confirm the association with adverse outcomes.

Optimizing antibiotic therapy is imperative with rising bacterial resistance and high infection mortality. Extended infusion defined as a continuous infusion (COI) or prolonged infusion (PI) of beta-lactams and glycopeptides might improve efficacy and safety compared to their intermittent administration (IA). This study aimed to evaluate the efficacy and safety of extended infusion in pediatric patients. Adhering to Cochrane standards, we conducted a systematic review with meta-analysis investigating the efficacy and safety of COI (24 h/d) and PI (>1 h/dose) compared to IA (≤1 h/dose) of beta-lactams and glycopeptides in pediatrics. Primary outcomes included mortality, clinical success, and microbiological eradication. Five studies could be included for the outcome mortality, investigating meropenem, piperacillin/tazobactam, cefepime, or combinations of these. The pooled relative risk estimate was 0.48 (95% CI 0.26–0.89, p = 0.02). No significant differences between the administration modes were found for the outcomes of clinical success, microbiological eradication (beta-lactams; glycopeptides), and mortality (glycopeptides). No study reported additional safety issues, e.g., adverse drug reactions when using COI/PI vs. IA. Our findings suggest that the administration of beta-lactams by extended infusion leads to a reduction in mortality for pediatric patients.

Background Patients in intensive care units (ICUs) are susceptible to medication errors (MEs) for many reasons, including the complexity and intensity of care. Little is known about patient safety culture, its relationship to medication safety, and ME prevention strategies used in ICUs. This study explored the attitudes of healthcare professionals (HCPs) working in ICUs or within medication safety towards patient safety culture, medication safety, and factors influencing implementation of ME prevention strategies in ICUs across Europe. Methods This qualitative study employed focus group discussions; ethical approval was obtained. Invitations to participate were distributed to HCPs working in ICUs or as medication safety officers across Europe. In May 2022, online focus group discussions were conducted. Discussions were transcribed verbatim and analysed. The framework analysis employed was inductive, systematic and transparent, and completed through a collaborative and iterative process. Results Three nurses and 11 pharmacists, from seven different countries, participated in three focus group discussions. There was a sense of improvement in blame culture leading to more open culture, although it was not the case for all participants. Blame culture, when present, was thought to be prevalent among more senior ICU staff and hospital managers. Facilitators for improving medication safety included communicating with HCPs and providing feedback on MEs and ME prevention strategies, interprofessional working without hierarchies, and having a ‘good’ culture and environment. Barriers included lack of engagement of HCPs and their attitudes towards medication safety, and an existing blame culture. Participants reported 25 different ME prevention strategies in use including: assessing knowledge; teaching and training; auditing practice; incident reporting; and involvement of pharmacists. Conclusions This study examined the attitudes of HCPs on patient safety culture and medication safety in the ICU setting in Europe and gained their insight into facilitators and barriers to the implementation of ME prevention strategies to improve medication safety.

Purpose: Outpatient parenteral antimicrobial therapy (OPAT) is a standard for antimicrobial therapy internationally. With this prospective cohort study, we aimed to assess the impact of an OPAT service as part of antimicrobial stewardship (ABS) and evaluate the safety and efficiency of the program while illuminating the financial benefit for the hospital. Methods: Socio-demographic data, treatment regimen and outcomes were prospectively recorded for all patients assigned to the program of the OPAT unit of the University Hospital of Zurich between November 2018 and September 2022. Results: In total, we recorded 303 OPAT assignments of which 260 resulted in effective OPAT episodes. The 260 OPAT episodes were further optimized towards the choice of antimicrobial substance (n=18) and length of therapy (n=6). Moreover, OPAT resulted in alteration of patient assessment and care led by ABS strategies in 247 of 260 episodes (95%). While the bed days saved per year increased consistently with time, a total of 3934 in-hospital treatment days were saved amounting to a cost saving of 9’835’000 CHF over 47 months. Adverse events were recorded in 46 cases whilst only two of these have been the reason for readmission during OPAT treatment. Clinical cure was noted in 77% (199/260) and was negatively associated with Charlson Comorbidity Index (CCI; OR per 1 unit higher 0.85 (95% CI 0.78-0.93)). Conclusion: This study demonstrates the impact of an OPAT service in the framework of ABS as well as its benefits for the hospital whilst preserving safety and efficacy for the patient’s parenteral antimicrobial treatment.