Background. OPAT is commonly administered at home. Such treatment has potential for the occurrence of antimicrobial adverse events (AEs) and vascular access complications that require clinical intervention. The purpose of this study was to examine adverse events and complications that occur during the course of OPAT at home.
Methods. All OPAT courses carried out at home for patients at Cleveland Clinic over one calendar year were identified from the institution's OPAT registry. AEs and vascular access complications that occurred during the treatment course were abstracted from the electronic medical record. Only AEs or complications that triggered a clinical intervention were included.
Results. From January 1, 2013 to January 1, 2014, 1464 patients received at 1950 OPAT courses at home, for a total of 43908 OPAT days of treatment. Mean patient age was 55 years. The most commonly prescribed antimicrobials were vancomycin (30% of courses), piperacillin-tazobactam (11%) and ceftriaxone (10%). 157 OPAT courses (8%) had at least one antimicrobial AE. A total of 216 antimicrobial AEs (4.92 per 1,000 OPAT days) were noted. The most common of these was a rash (25% of all AEs noted), followed by diarrhea (14%). The first antimicrobial AE occurred a median of 9.5 days after starting therapy. The vascular access device was a PICC in 1514 instances (78%). 176 OPAT courses (9%) had at least one vascular access complication. A total of 213 vascular access complications were noted in 176 OPAT courses. The first antimicrobial AE occurred a median of 10 days after starting therapy. The most common complication was occlusion (49%), followed by accidental dislodgement (14%). Thrombosis and line infection occurred in 15 (0.8%) and 7 (0.4%) of OPAT courses, respectively, at rates of 0.34 and 0.16 per 1,000 OPAT days.
Conclusion. During OPAT at home, 8% and 9% of OPAT courses, respectively, have at least one antimicrobial AE or vascular access complication requiring clinical intervention.
Disclosures. N. Shrestha, Forest: Speaker's Bureau, Speaker honorarium; Merck: Speaker's Bureau, Speaker honorarium; The Medicines Company: Scientific Advisor, Consulting fee S. J. Rehm, Pfizer: Scientific Advisor, Consulting fee; Merck: Scientific Advisor, Consulting fee