Safety of prolonged outpatient courses of intravenous antibiotics: a prospective cohort study.

OBJECTIVES: 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. METHODS: 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. RESULTS: 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). DISCUSSION: 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.

Determining the Risk of Sepsis Using Nurse-Compounded Elastomeric Pumps for Continuous Infusion in Outpatient Parenteral Antibiotic Therapy.

Limited availability of compounded antibiotics used for continuous infusion outpatient parenteral antibiotic therapy (OPAT) can delay or interrupt an OPAT course. To solve this problem, OPAT nurses at a hospital in Australia have been compounding elastomeric pumps for immediate use. The incidence of sepsis in 5014 patients before and after the introduction of nurse compounding was compared. There were no cases of laboratory-confirmed bloodstream infection among the nurse-compounded group compared with 2 cases (0.045/1000 catheter days) among the control group without nurse compounding (P = .16). No compounding medication errors occurred in more than 180 patient years of follow-up among the nurse compounding group. Nurse compounding can be a safe and convenient alternative when immediate access to preloaded elastomeric pumps is required.

Home intravenous antibiotic therapy and allergic drug reactions: is there a case for routine supply of anaphylaxis kits?

This study aimed to estimate the risk of an allergic reaction for patients receiving home intravenous antibiotics, and to identify the potential advantages and disadvantages of providing injectable epinephrine in this patient population. In this study, 770 patients received 1000 courses of home intravenous therapy with 25 different antibiotics for 37 conditions. The patients in the program experienced 28 allergic reactions. The mean time to allergic reaction was 19.6 days. No episodes of anaphylaxis were observed. These results, coupled with the potential disadvantages of issuing epinephrine to all patients receiving home antibiotic therapy, suggest that this strategy may not provide a net benefit.