Medical Inspection – Health Blog

Antimicrobial Regimen

Most of the patients in this study (54 or 82%) were treated with a single antimicrobial agent (Table 2). Cefazolin was the most frequently prescribed agent, and in 22 of the 31 courses of therapy with this drug, it was used to treat cellulitis. A combination of 2 parenteral antimicrobial agents was used in treating 11 patients, and 1 patient received 3 antibiotics concurrently. Endocarditis was the most common infection requiring combination IV therapy.

Treatment Duration

The total duration of combined inpatient and out­patient IV antimicrobial therapy ranged from 3 to 169 days (mean 32.8 days, median 23.5 days). The duration of OPAT varied between 2 and 169 days (mean 27.3 days; median 20.5 days).

Complications

Nineteen (29%) of the 66 patients in this study experienced a total of 25 complications (Table 3). Most of the complications (15 or 60%) were attributed to IV access as opposed to the antimicrobial agent (10 or 40%). The most common access-related complications were interstitial IV line, occlusion of the IV line, and phlebitis. Eight of the 14 patients with an access-related complication had a PICC line. viagra jelly

Nausea was the most common antimicrobial-related complication, and amphotericin B was associated with the greatest number of adverse effects. One patient experienced neutropenia associated with piperacillin/ tazobactam, which was recognized only upon readmission to hospital.

Table 2. Antimicrobial Agents Prescribed as Outpatient Parenteral Antibacterial Therapy (OPAT)

Outcomes

For most patients (56 or 85%), OPAT was successful. A large proportion of patients (40 or 61%) had asuccessful outcome with no complications related to OPAT, and 16 (24%) had a successful outcome but experienced a complication during their course of therapy. Of the latter group, 3 patients required a change in therapy because of an adverse event or complication. One of these patients, who was being treated with cefotaxime, experienced thrombophlebitis, and another patient, who was receiving concurrent cloxacillin and gentamicin, required a change in therapy after development of phlebitis and interstitial positioning of the IV line. The third patient experienced an allergic reaction, which resolved following a change in therapy.
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Of the 10 patients (15%) for whom OPAT failed, 5 were readmitted to hospital for reasons attributable to the infection and 5 experienced a worsening of the infection that required a change in the antimicrobial regimen. Of note, these patients all continued to receive the new antimicrobial regimen on an outpatient basis. None of the patients in this study had OPAT failure because of premature discontinuation of OPAT related to an adverse event or complication.Of the 5 patients who were readmitted to hospital, 1 patient required amputation as a consequence of poor healing of a diabetic ulcer with osteomyelitis, and another patient, who had a wound infection after heart surgery, was readmitted for treatment of newly diagnosed osteomyelitis. Two patients were readmitted for worsening infection (of a wound in 1 patient and cellulitis in 1 patient). The fifth patient with failed OPAT had an intra-abdominal abscess and was readmitted because of emergence of fever, chills, and abdominal pain.

Table 3. Types of Complications Experienced by 66 Patients Receiving Outpatient Parenteral Aantimicrobial Therapy

Monitoring

Only 12 patients (18%) had a monitoring plan identified in the health record. The monitoring plans included monitoring of serum electrolyte concentra­tions, complete blood cell count, and determination of serum concentrations of creatinine, blood urea nitrogen, gentamicin, or vancomycin. The results of these laboratory tests and the names of the physicians to whom these results were sent were not recorded in any of the charts reviewed.

Related Posts:

• A Review of Outpatient Parenteral Antimicrobial Therapy Practices: DISCUSSION part 2
• A Review of Outpatient Parenteral Antimicrobial Therapy Practices: DISCUSSION
• A Review of Outpatient Parenteral Antimicrobial Therapy Practices: Result
• A Review of Outpatient Parenteral Antimicrobial Therapy Practices: METHODS