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"The incidence of major adverse events during long courses of intravenous antibiotics is low, peaking in week two and tailing off thereafter" Browning et al (2022).

Long-term OPAT

Abstract:

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 randomised controlled trials demonstrate non-inferiority of 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 1st June 2009 and 30th 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 analysed.

Results: There were 4,160 admissions (median length of stay 20 days), and a total of 88,432 patient-days of observation. 135 (3.3% of admissions) experienced at least one major AE (1.54/1,000 patient days [95%CI: 1.29 to 1.82]). The risk of a major AE peaked in the second week of OPAT admission, with acute kidney injury (43/136, 32%) and severe cytopenia (42/136, 31%) being most common. At least one minor AE occurred in 38.3% (1,592/4,160) of admissions (26.4 per 1,000 patient days [95%CI: 25.4 to 27.5]), with central venous catheter related complications accounting for 71% (1658/2338).

Conclusions: The incidence of major adverse events during long courses of intravenous antibiotics is low, peaking in week two and tailing off thereafter. These results should inform decisions concerning the choice of intravenous versus oral antimicrobials.


Reference:

Browning S, Loewenthal MR, Freelander I, Dobson PM, Schneider K, Davis JS. Safety of prolonged outpatient courses of intravenous antibiotics: a prospective cohort study. Clin Microbiol Infect. 2022 Jan 8:S1198-743X(21)00728-X. doi: 10.1016/j.cmi.2021.12.020. Epub ahead of print. PMID: 35017063.