Clinical Observation: Outpatient Intravenous Antibiotic Therapy for Catheter Infections in Patients on Home Parenteral Nutrition

Abstract

Standard management of infectious complications in home parenteral nutrition (HPN) patients includes hospitalization and use of IV antibiotics (1 to 4 weeks). Outpatient IV antibiotic therapy (OPIVAT) has proven to be safe, practical and cost‐effective for a variety of infections. The aim of this retrospective review is to describe our experience with OPIVAT for suspected catheter‐related infections in patients receiving HPN. The records of all HPN patients in our program were reviewed. Since 1993, eleven adults and seven children received HPN for a total of 5420 and 1212 days respectively. During the follow‐up there were 21 febrile episodes in the adult patients, nine catheter‐related infections, and 12 non‐catheter‐related febrile episodes. All received initially empiric antibiotic treatment (Teicoplanin or Vancomycin plus Ceftriaxone). If the patient's general condition was good, the treatment was administered at home, otherwise he or she remained in the hospital until the results of the blood cultures were available. Most of the febrile episodes treated entirely at home corresponded to non‐catheter related infections. No patients developed complications related to infections. None of the patients with catheter‐related bloodstream infection who received OPIVAT needed to be admitted or readmitted to the hospital during the course of the treatment. It was only necessary to remove the catheter as an inpatient in one patient with a tunnel infection. In most of the HPN programs, if the patient presents fever and no infectious focus is found, admission is recommended. IV antibiotics are started until the results of blood cultures are available. Our findings suggest that, even in the presence of catheter‐related bloodstream infection, if the patient's general condition is good, antibiotic treatment can be safely administered at home.