Hoffman-Terry M L, Fraimow H S, Fox T R, Swift B G, Wolf J E
Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Am J Med. 1999 Jan;106(1):44-9. doi: 10.1016/s0002-9343(98)00362-3.
Although home parenteral antimicrobial therapy has become common, few studies have carefully examined its adverse effects.
We retrospectively reviewed the medical records of 269 patients who received 291 courses of home parenteral antimicrobial therapy through a hospital-based home infusion program during a 2-year period. Patients with human immunodeficiency virus (HIV) infection were not included.
The majority (59%) of patients were treated for bone and joint infections. Patients had a mean age of 47 years. The mean duration of antibiotic therapy was 40 days. Of monitored courses, leukopenia occurred in 16%, neutropenia in 7%, thrombocytopenia in 4%, and eosinophilia in 12%, usually after a month of therapy; these adverse effects were most frequently associated with the use of beta-lactam antibiotics. Nephrotoxicity occurred in 8% of monitored courses at a mean of 27 days and was most commonly associated with amphotericin B. Diarrhea occurred in 7% and rash in 4% of patients, and both were most commonly seen with beta-lactam antibiotics. Of those patients with permanent indwelling catheters, 11% of those with central catheters and 9% of those with peripherally inserted central catheters (PICCs) developed line complications. Overall, 8% of patients required rehospitalization.
Home infusion antibiotic therapy exposes patients to the complications associated with inpatient antibiotic therapy and needs to be monitored closely to prevent serious complications and rehospitalizations.
尽管家庭胃肠外抗菌治疗已变得普遍，但很少有研究仔细考察其不良反应。
我们回顾性分析了269例患者的病历，这些患者在两年期间通过一个基于医院的家庭输液计划接受了291个疗程的家庭胃肠外抗菌治疗。未纳入人类免疫缺陷病毒（HIV）感染患者。
大多数（59%）患者接受骨与关节感染治疗。患者平均年龄47岁。抗生素治疗的平均疗程为40天。在监测的疗程中，16%出现白细胞减少，7%出现中性粒细胞减少，4%出现血小板减少，12%出现嗜酸性粒细胞增多，通常在治疗一个月后出现；这些不良反应最常与β-内酰胺类抗生素的使用有关。8%的监测疗程出现肾毒性，平均发生时间为27天，最常与两性霉素B有关。7%的患者出现腹泻，4%出现皮疹，两者最常见于β-内酰胺类抗生素使用时。在有永久性留置导管的患者中，中心静脉导管患者有11%、外周静脉穿刺中心静脉导管（PICC）患者有9%发生导管相关并发症。总体而言，8%的患者需要再次住院。
家庭输液抗生素治疗使患者面临与住院抗生素治疗相关的并发症，需要密切监测以预防严重并发症和再次住院。
