Billmeyer Kaylyn N, Ross Jennifer K, Hirsch Elizabeth B, Evans Michael D, Kline Susan E, Galdys Alison L
University of Minnesota College of Pharmacy, Minneapolis, MN, USA.
M Health Fairview University of Minnesota Medical Center, Minneapolis, MN, USA.
Ther Adv Infect Dis. 2023 Jun 12;10:20499361231179668. doi: 10.1177/20499361231179668. eCollection 2023 Jan-Dec.
Select circumstances require outpatient parenteral antimicrobial therapy (OPAT). The potency of OPAT agents presents an increased risk of adverse events and unscheduled medical care. We analyzed these outcomes among OPAT recipients as part of the implementation of a collaborative OPAT program.
Adult patients discharged home from an academic hospital with OPAT between January 2019 and June 2021 were included in this retrospective cohort; participants discharged between June 2020 and June 2021 were part of the collaborative OPAT program. Patients with cystic fibrosis were excluded. Data on patient characteristics and outcomes were collected from electronic medical records by two reviewers. Multivariable analysis was conducted to identify predictors of vascular access device (VAD) complications, adverse drug events (ADEs), and OPAT-related emergency department (ED) visits and rehospitalizations.
Among 265 patients included in the cohort, 57 (21.5%) patients experienced a VAD complication; obesity [odds ratio (OR): 3.32; 95% confidence interval (CI): 1.38-8.73; = 0.01) and multi-drug therapy (OR: 2.56; 95% CI: 1.21-5.39; = 0.01) were associated with an increased odds of VAD complication. Eighty-two (30.9%) participants experienced an ADE; 30 (11.3%) experienced a severe/serious ADE. Lipo/glycopeptide receipt, (OR: 5.28; 95% CI: 1.89-15.43; < 0.01) and Black/African American race (OR: 4.85; 95% (CI): 1.56-15.45; < 0.01) were associated with an increased odds of severe/serious ADE. Inclusion in the OPAT collaborative was associated with a decreased odds of severe/serious ADE (OR: 0.26; 95% CI: 0.08-0.77; = 0.01). Fifty-eight (21.9%) patients experienced an OPAT-related ED visit and 53 (20.0%) experienced an OPAT-related rehospitalization. VAD complication (OR: 2.37; 95% (CI): 1.15-4.86, = 0.02) and ADEs (OR: 2.19; CI: 1.13-4.22; = 0.02) were associated with OPAT-related ED visits. ADE was associated with 90-day OPAT-related rehospitalization (OR: 3.21; (CI): 1.59-6.58; < 0.01).
Adverse safety events and OPAT-related unscheduled care occurred often in our cohort. A structured OPAT program that includes ID pharmacist antibiotic reconciliation may reduce rates of ADEs.
某些特定情况下需要进行门诊胃肠外抗菌治疗（OPAT）。OPAT药物的效力增加了不良事件和非计划医疗护理的风险。作为一项合作性OPAT项目实施的一部分，我们分析了接受OPAT治疗患者的这些结局。
纳入2019年1月至2021年6月间从一所学术医院出院并接受OPAT治疗的成年患者进行这项回顾性队列研究；2020年6月至2021年6月间出院的参与者是合作性OPAT项目的一部分。排除患有囊性纤维化的患者。由两名审阅者从电子病历中收集患者特征和结局的数据。进行多变量分析以确定血管通路装置（VAD）并发症、药物不良事件（ADE）以及与OPAT相关的急诊科（ED）就诊和再住院的预测因素。
该队列纳入的265例患者中，57例（21.5%）发生了VAD并发症；肥胖（比值比[OR]：3.32；95%置信区间[CI]：1.38 - 8.73；P = 0.01）和多药治疗（OR：2.56；95% CI：1.21 - 5.39；P = 0.01）与VAD并发症发生几率增加相关。82例（30.9%）参与者发生了ADE；30例（11.3%）发生了严重/重度ADE。接受脂肽/糖肽类药物治疗（OR：5.28；95% CI：1.89 - 15.43；P < 0.01）以及黑人/非裔美国人种族（OR：4.85；95% CI：1.56 - 15.45；P < 0.01）与严重/重度ADE发生几率增加相关。纳入OPAT合作项目与严重/重度ADE发生几率降低相关（OR：0.26；95% CI：0.08 - 0.77；P = 0.01）。58例（21.9%）患者发生了与OPAT相关的ED就诊，53例（20.0%）发生了与OPAT相关的再住院。VAD并发症（OR：2.37；95% CI：1.15 - 4.86；P = 0.02）和ADE（OR：2.19；CI：1.13 - 4.22；P = 0.02）与与OPAT相关的ED就诊相关。ADE与90天内与OPAT相关的再住院相关（OR：3.21；CI：1.59 - 6.58；P < 0.01）。
在我们的队列中，不良安全事件和与OPAT相关的非计划医疗护理经常发生。一个包括感染病学药师进行抗生素核对的结构化OPAT项目可能会降低ADE的发生率。
