Hale Cory M, Steele Jeffrey M, Seabury Robert W, Miller Christopher D
1 Department of Pharmacy, Upstate University Hospital, Syracuse, NY, USA.
2 Department of Medicine, Upstate Medical University, Syracuse, NY, USA.
J Pharm Pract. 2017 Dec;30(6):600-605. doi: 10.1177/0897190016688771. Epub 2017 Jan 23.
Despite the numerous benefits of outpatient parenteral antimicrobial therapy (OPAT), appreciable risks of drug-related problems (DRPs) exist. No studies to date comprehensively assess DRPs in this population.
Objectives of this study were to (1) characterize the frequency and types of DRPs experienced by patients discharged on OPAT and (2) determine the fraction of adverse drug reactions (ADRs) resulting in hospital readmission or emergency department (ED) presentation and changes in therapy.
This was a retrospective chart analysis evaluating consecutive adult patients discharged on OPAT between May 2015 and October 2015. Patients were assessed for the presence of DRPs until the cessation of antimicrobial treatment, including oral step-down therapy. The outcome of each ADR was recorded, including those resulting in hospital readmissions, presentation to the ED, or changes in antimicrobials.
Among 144 patients discharged on OPAT, 199 DRPs occurred in 91 (63.2%) patients. Harm and potential impaired efficacy occurred in 76.9% and 23.1%, respectively. The ADRs comprised 59% of DRPs, occurring in 44.4% of patients. The second most common DRP type was drug interactions (DIs), accounting for 22.6% of DRPs. Rifampin, fluoroquinolones, and daptomycin had the highest frequencies of preventable DRPs in the form of DIs, whereas cephalosporins had the fewest DRPs. Approximately 26% of ADRs caused changes in therapy and 9% resulted in hospital readmission or ED utilization.
DRPs with the potential to cause patient harm or impair treatment efficacy often occur with OPAT, most commonly ADRs and DIs. Enhanced monitoring and transitions of care management may reduce the incidence of these DRPs.
尽管门诊胃肠外抗菌治疗（OPAT）有诸多益处，但仍存在明显的药物相关问题（DRP）风险。迄今为止，尚无研究全面评估该人群中的DRP。
本研究的目的是：（1）描述接受OPAT出院患者经历的DRP的频率和类型；（2）确定导致再次入院或急诊就诊以及治疗改变的药物不良反应（ADR）的比例。
这是一项回顾性病历分析，评估2015年5月至2015年10月期间接受OPAT出院的连续成年患者。在抗菌治疗停止前，包括口服降阶梯治疗，评估患者是否存在DRP。记录每个ADR的结果，包括导致再次入院、急诊就诊或抗菌药物改变的情况。
在144例接受OPAT出院的患者中，91例（63.2%）患者发生了199次DRP。伤害和潜在疗效受损分别发生在76.9%和23.1%的患者中。ADR占DRP的59%，发生在44.4%的患者中。第二常见的DRP类型是药物相互作用（DI），占DRP的22.6%。利福平、氟喹诺酮类和达托霉素以DI形式出现的可预防DRP频率最高，而头孢菌素类的DRP最少。约26%的ADR导致治疗改变，9%导致再次入院或急诊就诊。
OPAT常发生可能导致患者伤害或损害治疗效果的DRP，最常见的是ADR和DI。加强监测和护理管理过渡可能会降低这些DRP的发生率。
