Intravenous catheter-related adverse events exceed drug-related adverse events in outpatient parenteral antimicrobial therapy

Abstract

BackgroundDrug-related adverse events (AEs) are reported to be common amongst patients receiving outpatient parenteral antimicrobial therapy (OPAT). However, comparative data regarding intravenous (iv) catheter-related AEs are lacking.ObjectivesTo compare drug- and iv catheter-related AEs from a large UK OPAT centre.Patients and methodsWe reviewed 544 OPAT episodes [median (IQR) age: 57 (39–71) years, 60% male, 13% with diabetes] with a median (IQR) duration of 7 (2–18) days. Clinically significant drug- and iv catheter-related AEs were calculated as a percentage of OPAT episodes with an AE and also as AEs per 1000 iv drug/catheter days.ResultsDrug-related AEs complicated 13 (2.4%) OPAT episodes at 1.7 (95% CI 0.9–2.9) per 1000 drug days. Catheter-related AEs occurred more frequently, complicating 32 (5.9%) episodes at 5.7 (95% CI 4.2–7.9) per 1000 iv catheter days (χ2 test for difference in AE rate: P < 0.001). Non-radiologically guided midline catheters were associated with the most frequent AEs (n = 23) at 15.6 (95% CI 10.3–23.4) per 1000 iv catheter days compared with other types of iv catheters (HR 8.4, 95% CI 2.4–51.9, P < 0.004), and self-administration was associated with a higher rate of catheter-related AEs at 12.0 (95% CI 6.0–23.9) per 1000 iv catheter days (HR 4.15, 95% CI 1.7–9.1, P = 0.007).ConclusionsClinically significant iv catheter-related AEs occurred more frequently than drug-related AEs, especially when using non-radiologically guided midline catheters. Regular review of the need for iv therapy and switching to oral antimicrobials when appropriate is likely to minimize OPAT-related AEs.

Clinical and Economic Impact of Implementing OVIVA Criteria on Patients With Bone and Joint Infections in Outpatient Parenteral Antimicrobial Therapy

“…We identified a total of 133 patients treated for BJI through our OPAT service, comprising approximately a quarter of all our OPAT patients (5). Non-vertebral, native osteomyelitis was the most common type of BJI, with a range of other native and prosthetic joint infections also being treated ( Table 1).…”

“…OVIVA provided strong evidence that BJI could be treated with appropriate oral antibiotic regimens, but most patients were recruited from two specialist bone and joint infection centres (7). Making use of a welldefined and prospectively recorded cohort of patients receiving OPAT (5,8), we provide the first real-world assessment that implementation of comparable criteria rendered the majority (80%) of our BJI cohort eligible for oral antibiotic treatment. We had elected not to participate in OVIVA as our practice at the time of recruitment was shorter than six weeks of IV therapy, reflected in median IV therapy duration of 29 days (IQR 18-45).…”

“…We utilised data collected prospectively into the OPAT database at University College London Hospitals (UCLH) NHS Foundation Trust (5,8). We included all patients with a BJI treated via OPAT between January 2015 and October 2018.…”

“…Delivery of IV therapy is increasingly provided by outpatient parenteral antimicrobial therapy (OPAT) services enabling earlier discharge from hospital (4). Although OPAT is effective and popular (4), it still carries risks of adverse events due to requirements for IV catheters (5) as well as the IV antibiotics being administered (6). Therefore, there has been great interest in the potential role of oral antibiotics in managing BJI.…”

“…These findings are potentially paradigm shifting, but the impact of implementing such a change on real-world practice remains unknown. We used the OVIVA study criteria to infer eligibility of patients with BJI in our OPAT service for oral antibiotic regimens and assess possible cost savings (5,8).…”