門診靜脈抗生素治療（OPAT）：感染管制與抗生素管理的新契機與挑戰

Outpatient Parenteral Antimicrobial Therapy: New Opportunities and Challenges in Infection Control and Antimicrobial Stewardship

門診靜脈抗生素治療（Outpatient Parenteral Antimicrobial Therapy，OPAT）係指於非住院環境中，在醫療團隊監督下持續給予靜脈抗生素之照護模式。隨2025年納入健保給付，OPAT成為我國感染症照護制度化轉型的重要里程碑。在嚴謹病人篩選、多專科合作與結構化監測制度下，OPAT可於確保療效與安全性的前提下完成長療程治療，並減少醫療環境暴露。然而，其衍生之相關問題如：中心靜脈導管相關血流感染（Central Line-Associated Bloodstream Infection，CLABSI）、不良事件與再住院等議題，需落實血管通路管理與退場機制。藥物選擇亦應與抗生素管理（Antimicrobial Stewardship，AMS）整合，並運用連續輸注以優化藥物動力學與藥效學（Pharmacokinetics／Pharmacodynamics，PK／PD）達成率。

Outpatient parenteral antimicrobial therapy (OPAT) refers to the delivery of intravenous antimicrobial agents in a non-inpatient setting under the supervision of a healthcare team. With its inclusion in Taiwan’s National Health Insurance reimbursement program in 2025, OPAT represents an important milestone in the institutional transformation of infectious disease care. On the basis of rigorous patient selection, multidisciplinary collaboration, and structured monitoring systems, OPAT enables the completion of prolonged antimicrobial therapy, while maintaining clinical efficacy and safety, and reducing exposure to healthcare environments. However, rather than being eliminated, the risk of infection shifts toward issues such as central line-associated bloodstream infections (CLABSI), adverse events, and hospital readmission, thereby highlighting the need for robust vascular access management and clearly defined exit strategies. Antimicrobial selection should be integrated with antimicrobial stewardship (AMS) principles, and continuous infusion strategies could be applied to optimize the attainment of pharmacokinetic/ pharmacodynamic (PK/PD) targets.