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. 2018 Apr;38(4):476-481.
doi: 10.1002/phar.2099. Epub 2018 Mar 30.

Antimicrobial Agents and Catheter Complications in Outpatient Parenteral Antimicrobial Therapy

Sara C Keller  1 , Kathryn Dzintars  2 , Lisa A Gorski  3 , Deborah Williams  4 , Sara E Cosgrove  1
Affiliations

Antimicrobial Agents and Catheter Complications in Outpatient Parenteral Antimicrobial Therapy

Sara C Keller et al. Pharmacotherapy. 2018 Apr.

Abstract

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.

Keywords: OPAT; antimicrobial therapy; catheter complications; parenteral antibiotics; venous catheter; vesicant.

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Conflict of interest statement

CONFLICT OF INTEREST STATEMENT

The authors have no conflicts of interest to declare.

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