Frisby Jared, Ali Naureen, Niemotka Samson, Abate Getahun
Division of Infectious Diseases, Doisy Research Center, Saint Louis University, 1100 S. Grand Blvd., Saint Louis, MO 63104, USA.
Antibiotics (Basel). 2023 Feb 4;12(2):330. doi: 10.3390/antibiotics12020330.
The infectious disease society of America (IDSA) recommends routine laboratory tests for all patients receiving outpatient parenteral antimicrobial therapy (OPAT) to monitor for adverse events. There are no data to support how often patients should take monitoring laboratory tests. In addition, the relevance of different laboratory tests commonly used for OPAT follow up is not clearly known.
We conducted a retrospective observational cohort study over a 7-year study interval (1 January 2014 to 31 December 2021). Clinical data were obtained to identify the risk factors associated with abnormal laboratory tests and determine if abnormal laboratory tests led to antibiotic change or hospital readmission.
Two hundred and forty-six patients met the inclusion criteria for this study. In our multivariate analysis, the Charlson comorbidity index (CCI) of 0-4 (aOR 0.39, 95%Cl 0.18-0.86), the use of ceftriaxone without vancomycin (aOR 0.47, 95%Cl 0.24-0.91) and an OPAT duration of 2-4 weeks (aOR 0.47, 95%Cl 0.24-0.91) were associated with a lower risk of OPAT complications. A CCI of 5 or more (aOR 2.5, 95%Cl (1.1-5.7)) and an OPAT duration of 5 or more weeks (aOR 2.7, 95% Cl 1.3-5.6) were associated with a higher risk of OPAT complications. An abnormal complete metabolic panel or vancomycin levels, but not an abnormal complete blood count, were associated with antibiotic change or readmission.
Patients with fewer comorbidities, ceftriaxone and short OPAT durations are at lower risk for OPAT complications. These patients could be followed with less frequent laboratory monitoring.
美国传染病学会（IDSA）建议对所有接受门诊胃肠外抗菌治疗（OPAT）的患者进行常规实验室检查，以监测不良事件。目前尚无数据支持患者应多久进行一次监测性实验室检查。此外，常用于OPAT随访的不同实验室检查的相关性尚不清楚。
我们在7年的研究期间（2014年1月1日至2021年12月31日）进行了一项回顾性观察队列研究。获取临床数据以确定与实验室检查异常相关的危险因素，并确定实验室检查异常是否导致抗生素更换或再次入院。
246例患者符合本研究的纳入标准。在我们的多变量分析中，Charlson合并症指数（CCI）为0 - 4（调整后比值比[aOR]0.39，95%置信区间[Cl]0.18 - 0.86）、使用头孢曲松而非万古霉素（aOR 0.47，95%Cl 0.24 - 0.91）以及OPAT持续时间为2 - 4周（aOR 0.47，95%Cl 0.24 - 0.91）与OPAT并发症风险较低相关。CCI为5或更高（aOR 2.5，95%Cl[1.1 - 5.7]）以及OPAT持续时间为5周或更长（aOR 2.7，95%Cl 1.3 - 5.6）与OPAT并发症风险较高相关。全代谢指标或万古霉素水平异常，但全血细胞计数异常则与抗生素更换或再次入院无关。
合并症较少、使用头孢曲松且OPAT持续时间较短的患者发生OPAT并发症的风险较低。这些患者可以减少实验室监测的频率。
