The Hospital for Tropical Diseases, Division of Infection, University College London Hospitals NHS Foundation Trust, London, UK.
Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK.
J Antimicrob Chemother. 2019 Mar 1;74(3):787-790. doi: 10.1093/jac/dky474.
Drug-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.
To compare drug- and iv catheter-related AEs from a large UK OPAT centre.
We 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.
Drug-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).
Clinically 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.
在接受门诊静脉注射抗生素治疗（OPAT）的患者中，药物相关不良反应（AE）报告较为常见。然而，关于静脉（iv）导管相关 AE 的比较数据尚缺乏。
比较英国一家大型 OPAT 中心的药物和 iv 导管相关 AE。
我们回顾了 544 例 OPAT 治疗[中位数（IQR）年龄：57（39-71）岁，60%为男性，13%合并糖尿病]，治疗持续时间中位数（IQR）为 7（2-18）天。以 AE 发生的 OPAT 治疗例数的百分比和每 1000 iv 药物/导管天的 AE 数来计算临床显著的药物和 iv 导管相关 AE。
13 例（2.4%）OPAT 治疗发生药物相关 AE，药物相关 AE 发生率为每 1000 药物天 1.7（95% CI 0.9-2.9）。导管相关 AE 更为常见，32 例（5.9%）OPAT 治疗发生导管相关 AE，发生率为每 1000 iv 导管天 5.7（95% CI 4.2-7.9）（差异的 χ2 检验：P<0.001）。非放射引导中线导管与最频繁的 AE（n=23）相关，每 1000 iv 导管天发生率为 15.6（95% CI 10.3-23.4），与其他类型的 iv 导管相比（HR 8.4，95% CI 2.4-51.9，P<0.004），自我管理与更高的导管相关 AE 发生率相关，每 1000 iv 导管天为 12.0（95% CI 6.0-23.9）（HR 4.15，95% CI 1.7-9.1，P=0.007）。
与药物相关 AE 相比，临床显著的 iv 导管相关 AE 更为常见，尤其是使用非放射引导中线导管时。定期评估 iv 治疗的必要性，并在适当情况下转为口服抗生素，可能会最大限度地减少 OPAT 相关 AE。
