{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T15:45:16Z","timestamp":1789487116605,"version":"build-2803163510"},"reference-count":48,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Self-administered outpatient parenteral antimicrobial therapy (S-OPAT) is an increasingly recognised antimicrobial delivery model, yet comparative evidence on its safety and effectiveness remains limited. We compared clinical outcomes across OPAT delivery models and examined predictors of adverse outcomes in S-OPAT. Adult OPAT episodes at a large UK teaching hospital (January 2023\u2013January 2026) were categorised as S-OPAT, healthcare professional home-administered (H-OPAT), or clinic-based (C-OPAT). Primary outcomes were treatment failure, complications, and 30-day unplanned hospitalisation. Outcome risks were compared using robust multivariable Poisson regression with generalised estimating equations and Bonferroni correction. Among 1064 OPAT episodes, 286 (26.9%) were S-OPAT, and cure\/clinical improvement occurred in 912\/1064 (85.7%). Treatment failure occurred in 26\/286 (9.1%) S-OPAT episodes, with no significantly higher risk than H-OPAT (adjusted relative risk [aRR], 0.72; 98.3% CI, 0.43\u20131.19) or C-OPAT (aRR, 0.94; CI 0.48\u20131.84). Rates of unplanned hospitalisation and OPAT-related complications were broadly comparable, except potentially vascular access-related events. Within S-OPAT, older age, higher comorbidity burden, diabetes, peripheral vascular disease, and central venous access were associated with treatment failure. Overall, these findings suggest that S-OPAT can be delivered safely and effectively to appropriately selected patients, while enhanced monitoring may be warranted for older individuals and those with greater comorbidity burden or central venous access devices.<\/jats:p>","DOI":"10.3390\/pathogens15090981","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T13:33:42Z","timestamp":1789479222000},"page":"981","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparing Self-Administered Outpatient Parenteral Antimicrobial Therapy (S-OPAT) with Alternative Delivery Models: Risk Factors for Treatment Failure and Complications in a UK Cohort"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3130-9724","authenticated-orcid":false,"given":"Oyewole Christopher","family":"Durojaiye","sequence":"first","affiliation":[{"name":"Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK"},{"name":"Department of Microbiology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Fiori","sequence":"additional","affiliation":[{"name":"Outpatient Parenteral Antimicrobial Therapy (OPAT) Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamille Jaff","family":"Maulion","sequence":"additional","affiliation":[{"name":"Outpatient Parenteral Antimicrobial Therapy (OPAT) Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9526-3852","authenticated-orcid":false,"given":"Evangelos I.","family":"Kritsotakis","sequence":"additional","affiliation":[{"name":"Laboratory of Biostatistics, School of Medicine, University of Crete, 71003 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"108554","DOI":"10.1016\/j.ijid.2026.108554","article-title":"Outpatient parenteral antimicrobial therapy (OPAT) programs for pediatric patients: A systematic review","volume":"167","author":"Neth","year":"2026","journal-title":"Int. J. Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"dlaf049","DOI":"10.1093\/jacamr\/dlaf049","article-title":"Quantifying cost savings from outpatient parenteral antimicrobial therapy programme: A systematic review and meta-analysis","volume":"7","author":"Mohammed","year":"2025","journal-title":"JAC Antimicrob. Resist."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Durojaiye, O.C., Fiori, C., and Cartwright, K. (2025). Delivery of outpatient parenteral antimicrobial therapy (OPAT) in an ever-changing National Health Service (UK): Benefits, barriers, and opportunities. Antibiotics, 14.","DOI":"10.3390\/antibiotics14050451"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"dkag068","DOI":"10.1093\/jac\/dkag068","article-title":"Stakeholder perspectives on the offer and acceptance of self-administration of outpatient parenteral antimicrobial therapy: A qualitative study","volume":"81","author":"Stoorvogel","year":"2026","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"dlaf030","DOI":"10.1093\/jacamr\/dlaf030","article-title":"The environmental impact of intravenous antimicrobial therapies: A comparison of OPAT and inpatient administration care pathways","volume":"7","author":"Cole","year":"2025","journal-title":"JAC Antimicrob. Resist."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"106559","DOI":"10.1016\/j.ijantimicag.2022.106559","article-title":"Survey of delivery of parenteral antimicrobials in non-inpatient settings across Europe","volume":"59","author":"Emilie","year":"2022","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2083","DOI":"10.1007\/s15010-025-02549-1","article-title":"Clinical and patient-reported outcomes of self-administered outpatient parenteral antimicrobial treatment (S-OPAT): A scoping review","volume":"53","author":"Maaskant","year":"2025","journal-title":"Infection"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e013560","DOI":"10.1136\/bmjopen-2016-013560","article-title":"Clinical and cost-effectiveness, safety and acceptability of community intravenous antibiotic service models: CIVAS systematic review","volume":"7","author":"Mitchell","year":"2017","journal-title":"BMJ Open"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1080\/1120009X.2023.2277507","article-title":"Effectiveness and safety of a disposable elastomeric continuous infusion pump for outpatient parenteral antimicrobial therapy (OPAT) in a UK setting","volume":"36","author":"Durojaiye","year":"2024","journal-title":"J. Chemother."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"100205","DOI":"10.1016\/j.clinpr.2022.100205","article-title":"Palliative outpatient parenteral antimicrobial therapy (OPAT): A single center experience and systematic scoping review","volume":"16","author":"Durojaiye","year":"2022","journal-title":"Clin. Infect. Pract."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/j.eimc.2024.04.001","article-title":"Outpatient parenteral antibiotic therapy (OPAT) through elastomeric continuous infusion pumps in a real-life observational study: Characteristics, safety, and efficacy analysis","volume":"42","author":"Giuliano","year":"2024","journal-title":"Enferm. Infecc. Microbiol. Clin."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic Dis."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2024). KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int., 105, S117\u2013S314.","DOI":"10.1016\/j.kint.2023.10.018"},{"key":"ref_14","unstructured":"British Society for Antimicrobial Chemotherapy (BSAC) (2018). The British Society for Antimicrobial Chemotherapy Outpatient Parenteral Antimicrobial Therapy National Outcomes Registry System (NORS) User Guide, BSAC. Available online: https:\/\/e-opat.com\/wp-content\/uploads\/2018\/12\/NORS-UserGuide-141218.pdf."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1093\/aje\/kwh090","article-title":"A modified Poisson regression approach to prospective studies with binary data","volume":"159","author":"Zou","year":"2004","journal-title":"Am. J. Epidemiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/EDE.0000000000001544","article-title":"An alternative perspective on the robust Poisson method for estimating risk or prevalence ratios","volume":"34","author":"Talbot","year":"2023","journal-title":"Epidemiology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1136\/bmj.310.6973.170","article-title":"Multiple significance tests: The Bonferroni method","volume":"310","author":"Bland","year":"1995","journal-title":"BMJ"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Bhavan, K.P., Brown, L.S., and Haley, R.W. (2015). Self-Administered outpatient antimicrobial infusion by uninsured patients discharged from a safety-net hospital: A propensity-score-balanced retrospective cohort study. PLoS Med., 12.","DOI":"10.1371\/journal.pmed.1001922"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1093\/jac\/dkm210","article-title":"Outpatient parenteral antimicrobial therapy (OPAT): Is it safe for selected patients to self-administer at home? A retrospective analysis of a large cohort over 13 years","volume":"60","author":"Matthews","year":"2007","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1111\/imj.16394","article-title":"Home nursing and self-administered outpatient parenteral antimicrobial treatment: A comparison of demographics and outcomes from a large regional hospital in Queensland, Australia","volume":"54","author":"Brand","year":"2024","journal-title":"Intern. Med. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e13216","DOI":"10.1111\/ijcp.13216","article-title":"Safety and effectiveness of \u2018hospital in the home\u2019 and \u2018outpatient parenteral antimicrobial therapy\u2019 in different age groups: A systematic review of observational studies","volume":"72","author":"Sriskandarajah","year":"2018","journal-title":"Int. J. Clin. Pract."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Sriskandarajah, S., Ritchie, B., Sluggett, J.K., Hobbs, J.G., and Reynolds, K.J. (2020). Safety of nurse- and self-administered paediatric outpatient parenteral antimicrobial therapy. Antibiotics, 9.","DOI":"10.3390\/antibiotics9110761"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1093\/jac\/dky474","article-title":"Intravenous catheter-related adverse events exceed drug-related adverse events in outpatient parenteral antimicrobial therapy","volume":"74","author":"Underwood","year":"2019","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1093\/jac\/dkv478","article-title":"Safety and effectiveness of outpatient parenteral antimicrobial therapy in older people","volume":"71","author":"Mujal","year":"2016","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_25","first-page":"433","article-title":"Frailty syndrome: An overview","volume":"9","author":"Chen","year":"2014","journal-title":"Clin. Interv. Aging"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.ccc.2020.08.006","article-title":"The effect of aging physiology on critical care","volume":"37","author":"Darden","year":"2021","journal-title":"Crit. Care Clin."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"14","DOI":"10.4212\/cjhp.3264","article-title":"Risk of treatment failure for prosthetic joint infections: Retrospective chart review in an outpatient parenteral antimicrobial therapy program","volume":"76","author":"Flaten","year":"2023","journal-title":"Can. J. Hosp. Pharm."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"905.e1","DOI":"10.1016\/j.cmi.2018.11.009","article-title":"Developing a risk prediction model for 30-day unplanned hospitalization in patients receiving outpatient parenteral antimicrobial therapy","volume":"25","author":"Durojaiye","year":"2019","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"dlad125","DOI":"10.1093\/jacamr\/dlad125","article-title":"Does comorbidity index predict OPAT readmission?","volume":"5","author":"Stubbs","year":"2023","journal-title":"JAC Antimicrob. Resist."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.ijid.2014.11.021","article-title":"Supervised self-administration of outpatient parenteral antibiotic therapy: A report from a large tertiary hospital in Australia","volume":"30","author":"Subedi","year":"2015","journal-title":"Int. J. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e15212","DOI":"10.1016\/j.heliyon.2023.e15212","article-title":"A single centre experience of prosthetic joint infection outcomes with outpatient parenteral antimicrobial therapy","volume":"9","author":"Kutubi","year":"2023","journal-title":"Heliyon"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Su\u00e1rez-Casillas, P., Mej\u00edas-Trueba, M., Mart\u00ednez Alemany, I., Navarro Amuedo, L., Praena Segovia, J., de Alarc\u00f3n Gonz\u00e1lez, A., Luque M\u00e1rquez, R., Palacios-Baena, Z.R., Carmona-Caballero, J.M., and S\u00e1nchez Oliva, J.M. (2026). Outpatient Parenteral Antimicrobial Therapy for Pseudomonas aeruginosa Infections: Effectiveness and Safety. Pharmaceutics, 18.","DOI":"10.3390\/pharmaceutics18050549"},{"key":"ref_33","first-page":"e49374","article-title":"Diabetes mellitus and prevalence of other comorbid conditions: A systematic review","volume":"15","author":"Bodke","year":"2023","journal-title":"Cureus"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1136\/bmj.39201.463819.2C","article-title":"Multimorbidity\u2019s many challenges","volume":"334","author":"Fortin","year":"2007","journal-title":"BMJ"},{"key":"ref_35","first-page":"e90983","article-title":"Navigating complexities: Clinical decision-making in patients with multiple comorbidities","volume":"17","author":"Umer","year":"2025","journal-title":"Cureus"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Sadeghi, H., Mohammadi Shahbolaghi, F., Hosseini, M., Fallahi-Khoshknab, M., and Ghaedamini Harouni, G. (2024). Factors associated with self-management in older adults with multiple chronic conditions: A qualitative study. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1412832"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1001\/jamainternmed.2021.6844","article-title":"Safety and outcomes of midline catheters vs peripherally inserted central catheters for patients with short-term indications: A multicenter study","volume":"182","author":"Swaminathan","year":"2022","journal-title":"JAMA Intern. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1001\/jamainternmed.2024.5984","article-title":"Midline vs peripherally inserted central catheter for outpatient parenteral antimicrobial therapy","volume":"185","author":"Paje","year":"2025","journal-title":"JAMA Intern. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1016\/j.ajic.2018.01.006","article-title":"Comparison of complications in midlines versus central venous catheters: Are midlines safer than central venous lines?","volume":"46","author":"Mushtaq","year":"2018","journal-title":"Am. J. Infect. Control"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1155\/2013\/205910","article-title":"Outpatient parenteral antimicrobial therapy","volume":"24","author":"Laupland","year":"2013","journal-title":"Can. J. Infect. Dis. Med. Microbiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2392","DOI":"10.1093\/jac\/dkx123","article-title":"Cost-effectiveness of outpatient parenteral antibiotic therapy: A simulation modelling approach","volume":"72","author":"Meads","year":"2017","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e049733","DOI":"10.1136\/bmjopen-2021-049733","article-title":"Outpatient parenteral antimicrobial therapy (OPAT) versus inpatient care in the UK: A health economic assessment for six key diagnoses","volume":"11","author":"Dimitrova","year":"2021","journal-title":"BMJ Open"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2083","DOI":"10.1093\/jac\/dkae177","article-title":"Current practices and challenges of outpatient parenteral antimicrobial therapy: A narrative review","volume":"79","author":"Wolie","year":"2024","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"dlag044","DOI":"10.1093\/jacamr\/dlag044","article-title":"2026 Updated good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) in adults and children in the UK","volume":"8","author":"Noble","year":"2026","journal-title":"JAC Antimicrob. Resist."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e027475","DOI":"10.1136\/bmjopen-2018-027475","article-title":"Home self-administration of intravenous antibiotics as part of an outpatient parenteral antibiotic therapy service: A qualitative study of the perspectives of patients who do not self-administer","volume":"9","author":"Tonna","year":"2019","journal-title":"BMJ Open"},{"key":"ref_46","first-page":"763","article-title":"Roles and role ambiguity in patient- and caregiver-performed outpatient parenteral antimicrobial therapy","volume":"45","author":"Keller","year":"2019","journal-title":"Jt. Comm. J. Qual. Patient Saf."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Clarkson, A.M., and Snape, S. (2024). Clinical effectiveness of continuous infusion flucloxacillin in the outpatient parenteral antimicrobial therapy (OPAT) setting in a UK Hospital: A service evaluation. Antibiotics, 13.","DOI":"10.3390\/antibiotics13020153"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1177\/1357633X221131842","article-title":"Effectiveness of telemedicine in outpatient parenteral antimicrobial therapy (Tele-OPAT): A systematic review","volume":"30","author":"Durojaiye","year":"2024","journal-title":"J. Telemed. Telecare"}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/15\/9\/981\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T13:44:13Z","timestamp":1789479853000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/15\/9\/981"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,15]]},"references-count":48,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["pathogens15090981"],"URL":"https:\/\/doi.org\/10.3390\/pathogens15090981","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,15]]}}}