Sriskandarajah Shanthy, Ritchie Brett, Sluggett Janet K, Reynolds Jodie G Hobbs And Karen J
Medical Device Research Institute, College of Science and Engineering, Flinders University, GPO Box 2100, Adelaide 5001, South Australia, Australia.
Infectious Diseases Department, Women's and Children's Hospital, North Adelaide 5006, Australia.
Antibiotics (Basel). 2020 Oct 30;9(11):761. doi: 10.3390/antibiotics9110761.
This study aimed to compare and contrast the safety and efficacy of nurse- and self-administered paediatric outpatient parenteral antimicrobial therapy (OPAT) models of care and to identify clinical factors associated with documented adverse events (AEs). A total of 100 OPAT episodes among children aged between 1 month and 18 years who were discharged from hospital and who received continuous 24 h intravenous antimicrobial therapy at home via an elastomeric infusion device were included. All documented AEs from the case notes were reviewed by a paediatrician and classified as either major or minor. Multivariable logistic regression was used to determine associations between clinical factors and any AE. A total of 86 patients received 100 treatment OPAT episodes (49 self-administered, 51 nurse administered). The most commonly prescribed antimicrobial via continuous infusion was ceftazidime (25 episodes). Overall, an AE was recorded for 27 (27%) OPAT episodes. Major AEs was recorded for 15 episodes and minor AEs were reported in 14 episodes. The odds of an AE was increased in episodes with self-administration (adjusted odds ratio (aOR) 6.25, 95% confidence interval (CI) 1.44-27.15) and where the duration of vascular access was >14 days (aOR 1.08, 95%CI 1.01-1.15). Our findings suggest minor AEs may be more frequently reported when intravenous antimicrobials are self-administered via 24 h continuous infusions.
本研究旨在比较和对比由护士给药和自我给药的儿科门诊胃肠外抗菌治疗（OPAT）护理模式的安全性和有效性，并确定与记录在案的不良事件（AE）相关的临床因素。纳入了100例1个月至18岁出院儿童的OPAT治疗案例，这些儿童在家中通过弹性输液装置接受24小时持续静脉抗菌治疗。儿科医生对病例记录中所有记录的AE进行了审查，并将其分为严重或轻微两类。采用多变量逻辑回归分析来确定临床因素与任何AE之间的关联。共有86例患者接受了100次OPAT治疗（49次自我给药，51次护士给药）。通过持续输注最常开具的抗菌药物是头孢他啶（25次）。总体而言，27例（27%）OPAT治疗记录了AE。记录了15次严重AE，14次轻微AE。自我给药的治疗案例中AE发生几率增加（调整后的优势比（aOR）6.25，95%置信区间（CI）1.44 - 27.15），以及血管通路持续时间>14天的案例（aOR 1.08，95%CI 1.01 - 1.15）。我们的研究结果表明，当通过24小时持续输注自我给予静脉抗菌药物时，轻微AE可能更频繁地被报告。
