Lane Michael A, Marschall Jonas, Beekmann Susan E, Polgreen Philip M, Banerjee Ritu, Hersh Adam L, Babcock Hilary M
Department of Internal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
Infect Control Hosp Epidemiol. 2014 Jul;35(7):839-44. doi: 10.1086/676859. Epub 2014 May 9.
To identify current outpatient parenteral antibiotic therapy practice patterns and complications.
We administered an 11-question survey to adult infectious disease physicians participating in the Emerging Infections Network (EIN), a Centers for Disease Control and Prevention-sponsored sentinel event surveillance network in North America. The survey was distributed electronically or via facsimile in November and December 2012. Respondent demographic characteristics were obtained from EIN enrollment data.
Overall, 555 (44.6%) of EIN members responded to the survey, with 450 (81%) indicating that they treated 1 or more patients with outpatient parenteral antimicrobial therapy (OPAT) during an average month. Infectious diseases consultation was reported to be required for a patient to be discharged with OPAT by 99 respondents (22%). Inpatient (282 [63%] of 449) and outpatient (232 [52%] of 449) infectious diseases physicians were frequently identified as being responsible for monitoring laboratory results. Only 26% (118 of 448) had dedicated OPAT teams at their clinical site. Few infectious diseases physicians have systems to track errors, adverse events, or "near misses" associated with OPAT (97 [22%] of 449). OPAT-associated complications were perceived to be rare. Among respondents, 80% reported line occlusion or clotting as the most common complication (occurring in 6% of patients or more), followed by nephrotoxicity and rash (each reported by 61%). Weekly laboratory monitoring of patients who received vancomycin was reported by 77% of respondents (343 of 445), whereas 19% of respondents (84 of 445) reported twice weekly laboratory monitoring for these patients.
Although use of OPAT is common, there is significant variation in practice patterns. More uniform OPAT practices may enhance patient safety.
确定当前门诊胃肠外抗生素治疗的实践模式及并发症。
我们向参与新发感染网络（EIN）的成人传染病医生发放了一份包含11个问题的调查问卷，EIN是美国疾病控制与预防中心在北美资助的一个哨点事件监测网络。该调查问卷于2012年11月和12月通过电子方式或传真进行分发。受访者的人口统计学特征从EIN登记数据中获取。
总体而言，555名（44.6%）EIN成员回复了调查问卷，其中450名（81%）表示他们在平均每月治疗1名或更多接受门诊胃肠外抗菌治疗（OPAT）的患者。99名受访者（22%）报告称，患者出院接受OPAT需要进行传染病会诊。住院传染病医生（449名中的282名[63%]）和门诊传染病医生（449名中的232名[52%]）常被确定为负责监测实验室结果。只有26%（448名中的118名）在其临床机构设有专门的OPAT团队。很少有传染病医生拥有跟踪与OPAT相关的错误、不良事件或“险些发生的失误”的系统（449名中的97名[22%]）。OPAT相关并发症被认为很少见。在受访者中，80%报告称管路阻塞或凝血是最常见的并发症（发生在6%或更多的患者中），其次是肾毒性和皮疹（各有61%的受访者报告）。77%的受访者（445名中的343名）报告对接受万古霉素治疗的患者进行每周一次的实验室监测，而19%的受访者（445名中的84名）报告对这些患者进行每周两次的实验室监测。
虽然OPAT的使用很普遍，但实践模式存在显著差异。更统一的OPAT实践可能会提高患者安全性。
