e68 Abstracts

ulcerative colitis. She deteriorated postoperatively; cavitat-ing lung lesions, multiple site embolisation to spleen,kidneys, small bowel, brain was confirmed on imaging;embolisation to limbs was noted. TOE showed an aortic valvevegetation; underwent further laparotomies for sepsis due tosmall bowel perforation. Histopathology of small bowelshowed evidence of angioinvasive aspergillosis; PCR ofhistopathology specimens, bronchoalveolar lavage cultureand galactomannan confirmed disseminated aspergillosis.She dramatically improved following antifungal therapywithresolution of her lesions in spite of no cardiac surgery.

Discussion

A small but increasing number of cases of IA are beingreported in patients with minimal immunocompromise.Mortality remains high in these patients and typically highrisk patient groups.

The only identifiable defence impairment in our patientwas a short course of corticosteroids; she had received noother immunosuppressants and the driver of her severe anddisseminated disease is uncertain. However, diagnosticdifficulties due to atypical presentation leading to delayeddiagnosis may have contributed. Also of interest is the rapidrecovery following antifungal therapy without cardiacsurgery; withdrawal of corticosteroids, however, mayhave contributed to this successful outcome.

Conclusions

It is noteworthy that the timing and the spectrum of diseaseassociated with IA has expanded in the recent past.

Corticosteroids in the doses our patient received arefrequently used in various common disease conditions. Therisk of opportunistic fungal infection in such a minimallyimmunocompromised patient is probably quite low ingeneral, however aspergillus infection should be increas-ingly considered in the differential diagnosis of pneumoniain the post surgical, critical care setting. Early diagnosisand reversal of immunosuppression along with prompttherapy may contribute to a good clinical outcome.

PATIENT/CARER RETENTION OF TRAINING INSELF-ADMINISTRATION OF OUTPATIENTPARENTERAL ANTIBIOTIC THERAPY (OPAT):A PROSPECTIVE STUDYCATEGORY: SCIENTIFICFREE PAPER

Julie Thornton, Kathryn Eaves, Ann LN ChapmanSheffield Teaching Hospitals NHS Foundation Trust,Sheffield, United Kingdom

Introduction

Outpatient Parenteral Antibiotic Therapy (OPAT) allowsoutpatient/community-based administration of intravenous(IV) antibiotics as an alternative to inpatient care. Therapy

may be administered by a nurse, or alternatively patients(or a carer) may be trained to self-administer; the latteroption allows greater flexibility for patients, and facilitatesadministration of multiple daily doses. Patient-adminis-tered OPAT has been shown to be as safe as nurse-administered therapy in large studies, but to date therehas been no formal assessment of individual patient/carerretention of training in antibiotic administration overa prolonged treatment course.

Patients or carers who had successfully completed ourformal training programme for IV antibiotic administrationthrough the Sheffield OPAT service were prospectivelyrecruited to the study. Towards the end of their treatmentcourse, their competence in self-administration was for-mally assessed by the OPAT Specialist Nurses using a stan-dard proforma. Five areas of competence were assessed:each was scored between 1 and 3 depending on the level ofperformance.

Scientific findings

15 patients participated in the study: IV antibiotic therapywas administered by the patient in 7 cases, and by a carerin 8 cases. Patients had a range of infections includingmalignant otitis externa, bronchiectasis, endocarditis,MRSA infection, mycobacterial infection, discitis and in-tra-abdominal sepsis. The median interval between com-pletion of training and further assessment was 55 days. 13/15 were scored as fully competent in all areas assessed. 2/15 (1 patient and 1 carer) were found not to be fullycompetent at re-assessment: both showed reduced com-pliance with sterile technique. None of the patients de-veloped line complications during therapy.

Discussion

OPAT has many advantages over traditional inpatient care,including improved patient convenience and reduced hos-pital admissions, length of stay and costs. However, thereare significant risks asssociated with outpatient parenteraltherapy, and these are in theory increased if therapy isadministered by anyone other than a healthcare profes-sional. Here we assessed patients’/carers’ retention offormal training in IV antibiotic administration after a pro-longed period. In most cases patients/carers retained theirtraining and performed competently on reassessment.However, in 2/15 cases there was either partial or completefailure to comply with the standard technique.

Conclusions

Patients/carers who will be administering IV antibiotictherapy through an OPAT programme should complete aninitial formal training programme to minimise the poten-tial risks of administration by a non-healthcare profes-sional. Their administration technique should be assessedregularly during therapy to identify potential faults at anearly stage.