Infection (2018) 46:349–355
Outpatient parenteral antibiotic therapy in a suburban tertiary referral
centre in Australia over 10 years
· James Branley
· Archana Sud
Received: 10 December 2017 / Accepted: 14 February 2018 / Published online: 20 February 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
Purpose Outpatient parenteral antibiotic therapy (OPAT) is a widely accepted and safe therapeutic option for carefully
selected patients. This study reviewed the practice of an OPAT service in a large Australian tertiary teaching hospital in
Western Sydney over a 10-year period.
Method Data were retrieved from a prospectively maintained electronic database which included information on patient
demographics, clinical diagnosis, microbiological identity, antimicrobial therapy, complications and readmissions. Data
were analysed using descriptive statistics.
Results There were 3435 referrals made to the service between January 2004 and June 2014, amounting to 25,289 antibiotic
days. The most frequent referral was for Skin and Soft Tissue Infections (SSTIs), 61.28%, followed by Bone and Joint Infec-
tions (BJIs), 15.30%. The most common organism identiﬁed was methicillin-sensitive Staphylococcus aureus. Readmission
was uncommon (5.15%), with the highest rate of readmission noted for Cardiovascular System Infections (16.67%) followed
by BJIs (10.31%). Line infection, aseptic thrombophlebitis and drug hypersensitivity or reaction were the cause of 68.55%
of all complications. There was a decline in line-related complications throughout the study period.
Conclusion OPAT service is in increasing demand in Australia, providing a signiﬁcant relief in in-hospital days. Growth in
referrals was seen not only with SSTIs and BJIs, but also a diverse range of other infective entities with limited literature in
its treatment in an OPAT setting. This study highlights the need to improve data collection, develop risk stratiﬁcation strate-
gies and standardisation of OPAT services in Australia.
Keywords Outpatient Parenteral Antibiotic Therapy (OPAT) · Outcomes · Complications · Readmissions · Australia
Outpatient parenteral antibiotic therapy (OPAT) has been
adopted worldwide as a means of providing safe, eﬃcacious
and cost-eﬀective care for patients at home. Since its initial
report in 1974, it has become a standard of care in providing
acute, sub-acute and post-acute care for patients at home .
The rapid growth of the service model is due to its recog-
nised advantage of allowing patients to return to the comfort
of their home early, reduce hospital-related complications
and reduce cost to the hospital system .
There are various models of care to provide the service.
A patient may receive intravenous therapy by attending an
infusion centre, or alternatively have a trained nursing staﬀ
administer the therapy at home as part of Hospital in the
Home (HITH). In some situations, a carer may be trained
to administer treatment at home . For the service to be
successful and safe, careful patient selection is essential;
they should be medically stable, reside predictably within
the catchment area, have adequate resources for activities
of daily living and be reliably contactable by the service
In Australia, OPAT programs began around the mid-
1990s . Since then it has been adopted in an increas-
ing number of settings including rural, paediatrics and
emergency; as well as for speciﬁc infective entities (such
as pneumonia and infective endocarditis) by some [6–11].
There is lack of uniformity with regard to medical govern-
ance, admission policy, clinical diagnoses accepted for care
* Wenlong Li
Present Address: Department of Infectious Diseases, Nepean
Hospital, Sydney, Australia
University of Sydney Medical School, Sydney, Australia