Abstract
BackgroundDrug-related adverse events (AEs) are reported to be common amongst patients receiving outpatient parenteral antimicrobial therapy (OPAT). However, comparative data regarding intravenous (iv) catheter-related AEs are lacking.ObjectivesTo compare drug- and iv catheter-related AEs from a large UK OPAT centre.Patients and methodsWe reviewed 544 OPAT episodes [median (IQR) age: 57 (39–71) years, 60% male, 13% with diabetes] with a median (IQR) duration of 7 (2–18) days. Clinically significant drug- and iv catheter-related AEs were calculated as a percentage of OPAT episodes with an AE and also as AEs per 1000 iv drug/catheter days.ResultsDrug-related AEs complicated 13 (2.4%) OPAT episodes at 1.7 (95% CI 0.9–2.9) per 1000 drug days. Catheter-related AEs occurred more frequently, complicating 32 (5.9%) episodes at 5.7 (95% CI 4.2–7.9) per 1000 iv catheter days (χ2 test for difference in AE rate: P < 0.001). Non-radiologically guided midline catheters were associated with the most frequent AEs (n = 23) at 15.6 (95% CI 10.3–23.4) per 1000 iv catheter days compared with other types of iv catheters (HR 8.4, 95% CI 2.4–51.9, P < 0.004), and self-administration was associated with a higher rate of catheter-related AEs at 12.0 (95% CI 6.0–23.9) per 1000 iv catheter days (HR 4.15, 95% CI 1.7–9.1, P = 0.007).ConclusionsClinically significant iv catheter-related AEs occurred more frequently than drug-related AEs, especially when using non-radiologically guided midline catheters. Regular review of the need for iv therapy and switching to oral antimicrobials when appropriate is likely to minimize OPAT-related AEs.
Highlights
Outpatient parenteral antimicrobial therapy (OPAT) prevents admission to hospital and facilitates early discharge.[1]
The clinical efficacy of OPAT compared with inpatient care appears equivalent,[1] placing an onus on ensuring that OPAT services are delivered safely, by quantifying the rate of adverse events (AEs), including those related to the use of intravenous (iv) catheters, and the antimicrobials administered.[2]
Both have been widely reported but often as an absolute proportion over the entirety of the OPAT care episode,[3,4,5,6] which is overly simplistic given the heterogeneity of OPAT indications, as risk is clearly related to the duration of the OPAT care episode.[7,8]
Summary
Outpatient parenteral antimicrobial therapy (OPAT) prevents admission to hospital and facilitates early discharge.[1] The clinical efficacy of OPAT compared with inpatient care appears equivalent,[1] placing an onus on ensuring that OPAT services are delivered safely, by quantifying the rate of adverse events (AEs), including those related to the use of intravenous (iv) catheters, and the antimicrobials administered.[2] Both have been widely reported but often as an absolute proportion over the entirety of the OPAT care episode,[3,4,5,6] which is overly simplistic given the heterogeneity of OPAT indications, as risk is clearly related to the duration of the OPAT care episode.[7,8]. In a recent US-based study, clinically significant drug-related AEs complicated 18% of OPAT care episodes at a rate of 2.24 events per 1000 OPAT care days. Drug-related adverse events (AEs) are reported to be common amongst patients receiving outpatient parenteral antimicrobial therapy (OPAT). Comparative data regarding intravenous (iv) catheter-related AEs are lacking
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