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Antimicrobial Agents and Catheter Complications in Outpatient Parenteral Antimicrobial Therapy
Author(s) -
Keller Sara C.,
Dzintars Kathryn,
Gorski Lisa A.,
Williams Deborah,
Cosgrove Sara E.
Publication year - 2018
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.2099
Subject(s) - medicine , antimicrobial , catheter , vancomycin , surgery , rate ratio , antimicrobial stewardship , prospective cohort study , confidence interval , intensive care medicine , staphylococcus aureus , antibiotics , antibiotic resistance , chemistry , organic chemistry , biology , bacteria , microbiology and biotechnology , genetics
Objectives Debate about whether certain antimicrobial agents traditionally considered vesicants increase the risk of catheter complications has led to uncertainty in venous catheter placement protocols. To understand whether patients requiring home‐based outpatient parenteral antimicrobial therapy ( OPAT ) should receive peripheral catheters (e.g., midline catheters) versus central venous catheters, and to understand whether certain antimicrobial agents place home‐based OPAT patients at higher risk for catheter complications, we investigated associations between antimicrobial agent(s) and catheter complications. Methods We performed a prospective cohort study of patients requiring home‐based OPAT discharged from two urban tertiary care academic medical centers, including telephone surveys and chart abstractions. Multivariable Poisson regressions were used to evaluate: (i) associations between antimicrobial agents traditionally considered vesicants, based on pH or osmolarity, and catheter complication rates, and (ii) associations between antimicrobial agent and rates of catheter complications. Results Vesicant antimicrobials defined using pH or osmolarity criteria were not associated with an increased rate of catheter complications (adjusted incidence rate ratio [ aIRR ]: 1.63, 95% confidence interval [ CI ]: 0.89–2.96). Vancomycin was associated with an increased rate of catheter complications, as was daptomycin ( aIRR : 2.32 [95% CI : 1.20–4.46] and 4.45 [95% CI : 1.02–19.41], respectively). Staphylococcus aureus infections were also associated with an increased rate of catheter complications ( aIRR : 2.13, 95% CI : 1.09–4.19), as were midline catheters ( aIRR : 9.44, 95% CI : 2.12–41.97). Conclusions Our study supports recent guidance identifying vancomycin as a vesicant, among a subset of antimicrobial agents, and removal of pH criteria for identification of vesicants.