Outpatient parenteral antimicrobial therapy (OPAT) for the management of periprosthetic joint infections in the Republic of Ireland (ROI) from 2013 to 2021

Abstract

Objectives

Periprosthetic joint infection (PJI) is a complication of joint arthroplasty and is seen in 1-2% of cases. Since its initiation in 2013, the national outpatient parenteral antimicrobial therapy (OPAT) program has facilitated the outpatient management of intravenous antimicrobials for PJI. This study aims to describe the clinical epidemiology of patients on OPAT with PJI between 2013 and 2021.

Methods

A retrospective analysis of patients discharged on OPAT between January 1, 2013 to August 31, 2021 was performed using data available from the national OPAT program. This study focused on those with a PJI. Data were analyzed using STATA/SE version 17.0.

Results

From January 1, 2013 until August 31, 2021, there were 14,749 patients managed through the national OPAT program, 8.35% (1232 of 14,749) of which were PJI. Of these, 53% (653 of 1232) were hip arthroplasty, 22.7% (280 of 1232) were knee arthroplasty, and 24.3% (299 of 1232) were “other.” The mean age was 64.5 years (SD 14.15 years). Of those on OPAT, 66.15% (815 of 1232) were health care–administered OPAT, whereas 33.85% (417 of 1232) were self-administered (S) OPAT (S-OPAT). Patients on S-OPAT were statistically younger (61 vs 66 years old, P <0.001, 95% confidence interval 14.1-63.6). The most common antimicrobial prescribed was daptomycin (35.8%; 441 of 1232), followed by ceftriaxone (21.2%; 262 of 1232). The median duration on the OPAT program was 27 days (interquartile range 14.5-35 days).

Conclusion

OPAT use in PJI is growing. Cumulatively, it has saved 26,992 hospital bed-days. Although S-OPAT is the preferred strategy and should be considered for all patients, our data demonstrate that health care–administered OPAT is required more frequently in older patients.