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Outpatient parenteral antimicrobial therapy‐treated bone and joint infections in a tropical setting

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Abstract

Background: Osteoarticular infections are a primary indication for outpatient parenteral antimicrobial therapy (OPAT). The climate and geographical diversity of tropical Australia, together with the prevalence of melioidosis, disseminated gonococcal disease and community‐acquired methicillin‐resistant Staphylococcus aureus renders this a challenging environment in which to manage such infections. We evaluated patients managed by the Royal Darwin Hospital Hospital in the Home service for bone and joint infections.

Methods: A retrospective analysis of the therapeutic outcomes at the end of intravenous therapy was carried out for patients treated between 1 January 2006 and 15 September 2007.

Results: Fifty‐five patients were treated, including 21 (38%) indigenous Australians and 18 (33%) from remote communities. Baseline characteristics were similar to other published data, but there were two cases each of gonococcal septic arthritis and melioidosis. During treatment, 39 (71%) lived at home, with five (9%) of these receiving treatment at community clinics. Thirteen (24%) resided in self‐care units in the hospital grounds. Three (5%) were managed at hostels or in prison. Median duration of parenteral therapy was 42 days, with a median of 22 days outside hospital, providing a total saving of 1307 bed‐days. Clinical success at end of therapy was 84%, with no significant difference between indigenous and non‐indigenous cohorts.

Conclusion: OPAT for osteoarticular infections is both feasible and effective in a tropical environment, including for indigenous patients. Extension of treatment to remote‐dwelling patients is facilitated by the innovative use of self‐care units and administration of treatment at remote clinics.
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Document Type: Research Article

Affiliations: Department of Infectious Diseases, Royal Darwin Hospital and

Publication date: 2011-09-01

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