VIENNA — Delivering intravenous (IV) antibiotics at home, supported by telemedicine monitoring, offered a safe and cost-effective alternative to prolonged hospitalization for complex cases, early findings from a pilot study suggested.

The approach combined outpatient parenteral antibiotic therapy (OPAT) with remote monitoring and was found to reduce hospital stay and healthcare-associated risks while maintaining high treatment success rates in an older, frail, and multi-morbid population.

“We are trying to change the model and bring the hospital into the home,” said Filomena Pietrantonio, MD, medical director of internal medicine at Castelli Hospital, Rome, Italy. “These are very complex patients who would otherwise require prolonged hospitalization for intravenous antibiotics.”

“Telemedicine transforms OPAT from feasible to safe,” she said. “Continuous remote monitoring enabled early detection of complications and supported integration between hospital and community care, a critical factor in managing high-risk patients outside traditional settings.”

The data were presented at 24th European Congress of Internal Medicine (ECIM) 2026.

Addressing a Growing Clinical Burden

Healthcare systems are increasingly managing older, frail patients with multiple comorbidities, many of whom require IV antibiotic treatment. Traditionally, this has meant extended hospital stays, contributing to pressures on bed capacity and exposing patients to hospital-associated complications, including healthcare-associated infections. This all underpinned the study rationale for shifting care of these patients into the community.

“Hospitalization itself carries risks, including healthcare-associated infections and functional decline, particularly in elderly patients,” Pietrantonio said.

Evidence already supports the use of OPAT and shows comparable clinical outcomes to inpatient care with success rates exceeding 80%-90%. However, concerns around safety and monitoring have limited wider adoption, said Pietrantonio.

Consequently,this study investigated OPAT in combination with telemedicine to maintain clinical oversight after discharge. Patients were monitored remotely via a cloud-based platform, allowing clinicians to track vital signs and respond rapidly to deterioration.

Pilot in Real-World Patients

The prospective observational pilot study enrolled 28 patients, with a planned expansion to 100. Participants were older with a mean age of 76 years, multimorbid, and clinically complex, reported Pietrantonio. The most common infections were urinary tract infections (50%), pneumonia (20%), intra-abdominal infections (18%), and skin and soft tissue infections (12%).

“Patients began treatment in hospital and were discharged home once clinically stable, where they continued intravenous antibiotics administered by visiting nurses, and supported by telemedicine follow-up,” explained Pietrantonio.

High Completion Rates, Low Readmissions

Of the 28 patients treated, 23 (82.1%) successfully completed OPAT without readmission and five patients (17.9%) required early readmission.

Pietrantonio explained that the reasons for readmission were consistent with the complexity of the population and included clinical deterioration, persistent infection, inadequate response to antibiotics, and complications related to comorbidities or medical devices.

“Importantly, the study identified predictors of failure, including fever at discharge, lack of reduction in inflammatory markers including CRP [C-reactive protein] and procalcitonin, and the presence of invasive devices. These findings highlight the importance of careful patient selection,” Pietrantonio said. “Patients must be clinically stable before discharge and early biochemical response should guide decisions.”

Significant Resource and Cost Savings With Caveats

One of the most striking findings was the impact on hospital resource use, said Pietrantonio. The model enabled early discharge of stable patients, avoiding a total of 138 hospital days. This translated into an estimated cost saving of approximately €96,600, alongside reductions in bed occupancy and improved turnover of acute care beds.

Beyond economics, the clinical implications were notable. “Reducing time spent in-hospital lowered exposure to healthcare-associated infections and helped mitigate functional decline in elderly patients,” Pietrantonio said. “These are patients who often deteriorate simply from being in hospital, so keeping them at home, when safe, is beneficial both clinically and psychologically.”

The model, known as frontiers in healthcare-associated infection therapy for OPAT and telemedicine, represents a shift toward integrated care, linking hospital services with community-based monitoring, Pietrantonio said.

She added that further validation in larger populations is needed and that future work will focus on expanding the cohort, integrating the model into regional healthcare systems, and developing standardized OPAT-telemedicine protocols.

While preliminary, the findings add to a growing body of evidence supporting OPAT as a safe alternative to inpatient care, particularly when combined with structured monitoring. “We show that OPAT combined with telemedicine is a safe and feasible alternative to prolonged hospitalization, but success depends on careful patient selection and close monitoring.”

Implementation Challenges May Limit Use

During the discussion, session moderator, Alexis Müller-Marbach, MD, head of the Gastroenterology Clinic at Deutsche Clinic Allianz, Düsseldorf, Germany, welcomed the work but noted the barriers faced in other healthcare systems, particularly workforce and funding constraints.

“I think this is really a hot topic,” he said. “In Germany, we would like to achieve this kind of outpatient antibiotic care, but we struggle. We do not have enough nurses and teams to support it, and funding is also a major issue.”

Pietrantonio suggested that demonstrating cost savings could help drive policy change. “If you save hospital days, and one day in internal medicine costs around €600, you can substantially reduce healthcare expenditure,” she said. “It becomes a matter of convincing policymakers that bringing the patient home is the right solution.”

Pietrantonio and Müller-Marbach reported having no relevant financial relationships.