Radboud University Medical Center, Department of Internal Medicine, Nijmegen, the Netherlands; Radboud University Medical Center, IQ Health Science Department, Nijmegen, the Netherlands; Radboud University Medical Center, Radboudumc Community for Infectious Diseases (RCI), Nijmegen, the Netherlands.
Radboud University Medical Center, Department of Internal Medicine, Nijmegen, the Netherlands; Radboud University Medical Center, Radboudumc Community for Infectious Diseases (RCI), Nijmegen, the Netherlands.
J Infect. 2024 Nov;89(5):106301. doi: 10.1016/j.jinf.2024.106301. Epub 2024 Sep 30.
Evidence on the optimal frequency of laboratory testing during outpatient parenteral antimicrobial therapy (OPAT) is lacking. Therefore, we investigated how often and when laboratory abnormalities occur during OPAT and which factors are associated with these abnormalities.
We performed a multicenter cohort study in four Dutch hospitals among adult patients receiving OPAT and collected routinely obtained laboratory test results. Incidence and incidence rates were calculated for various laboratory abnormalities. Survival analysis was performed to visualize the time to the first occurrence of laboratory abnormalities and Poisson regression analysis to compare the number of abnormalities in the first and second 30 OPAT days among patients receiving OPAT for ≥60 days. Predictors were identified using a multivariable Cox proportional hazard regression model.
45.1% of 1152 included patients developed laboratory abnormalities, but only 2% led to OPAT discontinuation. Hepatotoxicity was most common (33.9 events/1000 OPAT days), with a time-dependent decrease in the occurrence of the first hepatotoxic event, while hypokalemia was rare (1.7 events/1000 OPAT days). In the subgroup of patients receiving ≥60 days of OPAT, nephrotoxicity was more common in days 31-60. We observed partly toxicity-specific associations between antibiotic type, concomitant medication, baseline laboratory values, patient characteristics, and the occurrence of laboratory abnormalities.
While laboratory abnormalities are frequently observed during OPAT, they rarely lead to discontinuation of OPAT. Specific patient, treatment and laboratory characteristics were associated with the occurrence of laboratory abnormalities. Based on our results, we recommend a more personalized laboratory monitoring policy with less blood sampling.
缺乏门诊静脉用抗菌药物治疗（OPAT）期间实验室检测最佳频率的证据。因此，我们研究了 OPAT 期间实验室异常发生的频率和时间，以及哪些因素与这些异常相关。
我们在荷兰的四家医院进行了一项多中心队列研究，纳入接受 OPAT 的成年患者，并收集常规获得的实验室检测结果。计算了各种实验室异常的发生率和发生率。进行生存分析以可视化首次发生实验室异常的时间，并进行泊松回归分析，以比较接受≥60 天 OPAT 的患者在前 30 天和后 30 天 OPAT 期间异常的数量。使用多变量 Cox 比例风险回归模型识别预测因子。
1152 例纳入患者中 45.1%发生了实验室异常，但仅有 2%导致 OPAT 中断。肝毒性最常见（33.9 例/1000 天 OPAT），首次肝毒性事件的发生呈时间依赖性减少，而低钾血症罕见（1.7 例/1000 天 OPAT）。在接受≥60 天 OPAT 的患者亚组中，第 31-60 天更易发生肾毒性。我们观察到抗生素类型、合并用药、基线实验室值、患者特征与实验室异常发生之间存在部分特定毒性相关性。
虽然 OPAT 期间经常观察到实验室异常，但它们很少导致 OPAT 中断。特定的患者、治疗和实验室特征与实验室异常的发生相关。基于我们的结果，我们建议采用更个性化的实验室监测策略，减少采血。
