Department of Infectious Diseases, John Hunter Hospital, Newcastle, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
Department of Infectious Diseases, John Hunter Hospital, Newcastle, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
Clin Microbiol Infect. 2022 Jun;28(6):832-837. doi: 10.1016/j.cmi.2021.12.020. Epub 2022 Jan 8.
The perceived need for prolonged intravenous antibiotic courses has become a major driver behind the growth of outpatient parenteral antimicrobial therapy (OPAT) services. Several recent randomized controlled trials demonstrate noninferiority of an early switch to oral therapy and highlight the need to accurately quantify harms associated with OPAT.
We conducted a 10-year prospective cohort study in a tertiary hospital OPAT service. Adults admitted to the service between 1 June 2009 and 30 June 2019 who received an intravenous antimicrobial agent were included. Adverse events (AEs) attributable to intravenous antibiotics or intravenous access were recorded in a prospectively maintained database and analyzed.
There were 4160 admissions (median length of stay: 20 days) and a total of 88 432 patient-days of observation; 135 patients (3.3% of admissions) experienced at least one major AE (1.54 per 1000 patient-days; 95% CI, 1.29-1.82). The risk of a major AE peaked in the second week of OPAT admission, with acute kidney injury (43 of 136; 32%) and severe cytopenia (42 of 136; 31%) being the most common. At least one minor AE occurred in 38.3% of admissions (1592 of 4160; 26.4 per 1000 patient-days; 95% CI, 25.4-27.5), with central venous catheter-related complications accounting for 71% of AEs (1658 of 2338).
The incidence of major AEs during long courses of intravenous antibiotics is low, peaking in week 2 and tailing off thereafter. These results should inform decisions concerning the choice of intravenous versus oral antimicrobials.
人们普遍认为需要长时间静脉使用抗生素，这成为开展门诊静脉抗菌药物治疗（OPAT）服务的主要驱动力。几项最近的随机对照试验证明，早期转为口服治疗具有非劣效性，并强调需要准确量化 OPAT 相关危害。
我们在一家三级医院的 OPAT 服务中进行了一项为期 10 年的前瞻性队列研究。纳入 2009 年 6 月 1 日至 2019 年 6 月 30 日期间入住该服务的成年人，他们接受了静脉抗菌药物治疗。在一个前瞻性维护的数据库中记录并分析与静脉内抗生素或静脉通路相关的不良事件（AE）。
共纳入 4160 例住院患者（中位住院时间：20 天）和 88432 患者日的观察时间；135 例患者（住院患者的 3.3%）发生至少 1 例重大 AE（1.54/1000 患者日；95%CI，1.29-1.82）。OPAT 入院后第二周，重大 AE 风险达到高峰，急性肾损伤（136 例中的 43 例；32%）和严重血细胞减少症（136 例中的 42 例；31%）最常见。38.3%的住院患者（4160 例中的 1592 例）至少发生 1 例轻度 AE（26.4/1000 患者日；95%CI，25.4-27.5），其中中心静脉导管相关并发症占 AE 的 71%（2338 例中的 1658 例）。
长时间静脉使用抗生素期间重大 AE 的发生率较低，在第 2 周达到高峰，随后逐渐下降。这些结果应有助于决策是选择静脉用还是口服抗菌药物。
