Table 2 Causative organisms and antimicrobial management on OPAT
Patient No. | Organism(s) Cultured | Antimicrobial therapy 1 | Antimicrobial 2 (switch reason) | Antimicrobial 3 (switch reason) | Antimicrobial 4 (switch reason) | Oral suppression |
|---|---|---|---|---|---|---|
1 | Bacteroides fragilis (blood culture) | Ertapenem + metronidazole (OPAT, 6 weeks) | PO Moxifloxacin (oral consolidation) | Co-trimoxazole, RIP on suppression | ||
2 | Salmonella enteritidis, Streptococcus anginosis (blood culture, sac aspirate) | Ceftriaxone, 6 weeks | PO Co-trimoxazole (oral consolidation) | Co-trimoxazole | ||
3 | None | Ertapenem+ daptomycin, 6 weeks | PO cefuroxime (oral consolidation) | Co-trimoxazole | ||
4 | None | Ertapenem + daptomycin, 8 weeks | PO Linezolid + cefixime (oral consolidation) | Ertapenem and daptomycin (rising inflam markers) | PO Linezolid + cefuroxime | Cefuroxime |
5 | CoNS, (sac aspirate) | Piperacillin- Tazobactam + daptomycin | Teicoplanin +linezolid (admitted for graft reposition, unclear reason for antibiotic change) | Piperacillin- Tazobactam + daptomycin, 6 weeks | PO Ciprofloxacin +metronidazole (oral consolidation) | Co-trimoxazole, RIP on suppression |
6 | None | Co- Amoxiclav IV, 6 weeks | Cefuroxime PO (oral consolidation) | Amoxicillin | ||
7 | None | Co-amoxiclav IV, 6 weeks | Co-amoxiclav PO (oral consolidation, 6 months) | None | ||
8 | Enterococcus faecalis, Bacteroides caccae (vertebral biopsy) | Ertapenem+metronidazole, 8 weeks | Meropenema + caspofungina + PO linezolid (deterioration and pain) | Meropenema, PO fluconazole (anaemia on linezolid and caspofungin) | Co-amoxiclav + Fluconazole | |
9 | Pseudomonas (sac aspirate, blood culture) | Piperacillin-tazobactam + IV/PO ciprofloxacin on and off × 1 year, on OPAT between multiple temporising measures | Piperacillin-tazobactam + daptomycin (added for pneumonia) | Vancomycin (admitted with pneumonitis on daptomycin) + meropenem (later rash on piperacillin-tazobactam) | PO Ciprofloxacin + PO co-amoxiclav (oral suppression) | Ciprofloxacin + co-amoxiclav |
10 | MSSA, Pseudomonas aeruginosa, anaerobes, CoNS, Enterococcal sp. (VRE) – (sinus swabs/excision) | Piperacillin-tazobactam + PO rifampicin, 12 weeks | PO Ciprofloxacin (oral consolidation, 1 year) | Meropenem + daptomycin (re-treatment 2 years later) | Ertapenem + daptomycin (OPAT, 6 months) | Ciprofloxacin |
11 | Staphylococcus caprae, candida (excised sinus) | Piperacillin-tazobactam, 12 weeks | PO co-amoxiclav (oral consolidation) | Daptomycin (admitted with pneumonia) | Vancomycin (eosinophilia on daptomycin) | RIP 5 months, inpatient on IV antibiotics for pneumonia |