Risk of venous thromboembolism in patients treated for bacterial infection in the community with outpatient parenteral antimicrobial therapy

Barr, David; Irvine, S. Rodman; Ritchie, Neil D.; McCutcheon, J.; Seaton, R.A.

doi:10.1093/qjmed/hct239

Cited by 6 publications

(10 citation statements)

References 11 publications

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“…Although key performance indicators for CRT during OPAT have not been agreed to, the frequency of CRT we observed during OPAT is comparable to that described in the published literature, which ranges from 0% to 6% of patients, 1,4 or 0.39–0.48 CRT per 1000 catheter days. 4,5 Whilst CRT were infrequent in our setting, their consequences were significant, with almost half (47%) resulting in unplanned readmission and 11% associated with pulmonary embolism.…”

Section: Discussionsupporting

confidence: 82%

“…A recent French study observed similar rates of readmission (75%) and pulmonary emboli (12%) amongst patients with CRT. 5 Treatment related adverse events and unplanned readmissions have been proposed as OPAT quality indicators, 8 and so risk of CRT has become a pressing issue for OPAT clinicians, 1 52% of whom report CRT amongst their patients within the last year. 8…”

Section: Discussionmentioning

confidence: 99%

“…9 Whilst CRT risk factors are well defined in inpatient settings, 5 they remain poorly defined in the OPAT environment. 1…”

Section: Introductionmentioning

confidence: 99%

“…Outpatient parenteral antimicrobial therapy (OPAT) is an emerging model of health care delivery, 1 in which hospital admission is avoided or abbreviated via antimicrobial administration in the ambulatory setting, with vascular access usually facilitated by a peripherally inserted central catheter (PICC). 2,3 Thrombosis is one of the most frequent catheter related complications, 4 and is associated with increased costs, 5 interruption of antimicrobial therapy, readmission and rarely pulmonary embolism.…”

Section: Introductionmentioning

confidence: 99%

“…9 Whilst CRT risk factors are well defined in inpatient settings, 5 they remain poorly defined in the OPAT environment. 1 We aimed to assess the risk of CRT during OPAT, and identify patient, infection or treatment related risk factors that might guide future preventative interventions.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for catheter related thrombosis during outpatient parenteral antimicrobial therapy

et al. 2021

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Background: Outpatient parenteral antimicrobial therapy (OPAT) delivery using peripherally inserted central catheters is associated with a risk of catheter related thrombosis (CRT). Individualised preventative interventions may reduce this occurrence, however patient selection is hampered by a lack of understanding of risk factors. We aimed to identify patient, infection or treatment related risk factors for CRT in the OPAT setting. Methods: Retrospective case control study (1:3 matching) within OPAT services at two tertiary hospitals within Australia. Results: Over a 2 year period, encompassing OPAT delivery to 1803 patients, there were 19 cases of CRT, giving a prevalence of 1.1% and incidence of 0.58/1000 catheter days. Amongst the cases of CRT, there were nine (47%) unplanned readmissions and two (11%) pulmonary emboli. Compared to controls, cases had a higher frequency of malposition of the catheter tip (4/19 (21%) vs 0/57 (0%), p = 0.003) and complicated catheter insertion (3/19 (16%) vs 1/57 (2%), p = 0.046). Conclusions: Although CRTs during OPAT are infrequent, they often have clinically significant sequelae. Identification of modifiable vascular access related predictors of CRT should assist with patient risk stratification and guide risk reduction strategies.

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