Safety of continuous antibiotic infusions administered through an Australian hospital in the home service: a pilot study

Abstract

Background Few studies have assessed the safety of antibiotic infusions in the hospital in the home (HITH) setting, or the vascular access and ambulatory infusion devices used for delivering these infusions. Aim To explore treatments and health outcomes for HITH patients administered continuous antibiotic infusions through an ambulatory infusion device. Method Case notes for patients managed by a HITH service affiliated with a large metropolitan hospital were retrospectively audited. Consecutive patients treated for cellulitis, osteomyelitis, endocarditis, diabetic foot infection or septic arthritis between January and September 2014, and receiving intravenous antibiotic therapy through an ambulatory infusion device, were included. Patients were followed until discharge from HITH to determine adverse outcomes related to antibiotic therapy, including administration devices. Results The audit recruited 31 patients with a median age of 62 years; 17 (55%) were male. Overall 14 adverse events were experienced by 10 (32%) patients. Of the 14 adverse events, nine (64%) were medication‐related, one (7%) related to a vascular access device and four (29%) were infusion device‐related. Therapeutic failure occurred in four patients; three were re‐hospitalised; and one had their therapy extended. Most patients had an infusion that was identified as not running to completion on at least one occasion at the time of their home visit (81%), or problems with flushing lines or aspirating blood from the vascular access devices (35%). Conclusion Adverse events were commonly observed among patients receiving continuous antibiotic infusions in this pilot study. Further research is needed to identify patients at risk of adverse events.

Total intended antibiotic delivery related to drug concentration affecting the flow rate of elastomeric devices used in outpatient parenteral antimicrobial therapy (OPAT)

“…These residual volumes are more likely to imply an incomplete infusion. Incomplete infusions have been confirmed as a problem in the OPAT setting in previous studies . The present study demonstrates that the higher doses may be a contributing factor.…”

“…Many studies have investigated drug stability in extended infusions in the outpatient parenteral antimicrobial therapy (OPAT) setting to ensure patients receive their intended dose of therapy . However, few studies have investigated the performance of the devices used or specifically any factors that may affect the total dose patients gets in this setting . These other factors may result in larger dose deficits for the patient than drug degradation, and must be understood to ensure best possible patient care.…”

“…[1][2][3][4][5] However, few studies have investigated the performance of the devices used or specifically any factors that may affect the total dose patients gets in this setting. 6,7 These other factors may result in larger dose deficits for the patient than drug degradation, and must be understood to ensure best possible patient care.…”

Protocol for a randomised crossover trial to evaluate patient and nurse satisfaction with electronic and elastomeric portable infusion pumps for the continuous administration of antibiotic therapy in the home: the Comparing Home Infusion Devices (CHID) study

“…Disposable elastomeric pumps are widely used for home infusions, both in Australia 5 and internationally. 1 Elastomeric pumps contain a fluid reservoir made of a flexible elastomer that is stretched when filled, creating a high driving pressure.…”

“… 1 9 19 Difference between clinical and calibrated conditions may result in flow rate variations of up to ±50%. 5 15 …”