Which Patients Discharged to Home-Based Outpatient Parenteral Antimicrobial Therapy Are at High Risk of Adverse Outcomes?
Which Patients Discharged to Home-Based Outpatient Parenteral Antimicrobial Therapy Are at High Risk of Adverse Outcomes?
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DOI：
10.1093/ofid/ofaa178
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发表时间：
2020-06-01
影响因子：
4.2
通讯作者：
Cosgrove, Sara E.
中科院分区：
文献类型：
--
作者：
Keller, Sara C.;Wang, Nae-Yuh;Cosgrove, Sara E.
背景。越来越多的患者接受家庭门诊肠外抗菌治疗 (OPAT)。了解哪些患者可能面临更高的并发症风险对于出院时和出院后有效分类资源至关重要。方法。 2015 年 3 月至 2018 年 12 月期间从马里兰州巴尔的摩 2 个学术医疗中心之一出院的前瞻性队列患者获得同意并随机分为推导队列和验证队列，以制定不良 OPAT 结局的风险评分。对来自主要结局为严重不良结局（感染复发、严重不良药物事件、严重导管并发症、再入院或死亡）的衍生队列的数据进行分析，以使用逻辑回归导出风险评分方程，然后在验证队列中对其预测严重不良结局的性能进行验证。结果。在整个队列的 664 名患者中，一半 (332) 经历了严重的不良后果。预测出现严重不良结果的模型包括导管类型、OPAT 治疗时间、使用导管进行化疗、使用导管进行家庭肠外营养、接受化脓性关节炎治疗、接受万古霉素治疗、接受肠球菌治疗、接受真菌感染治疗以及接受经验治疗。在推导队列和验证队列中，严重不良结果评分 >= 2 的严重不良结果的敏感性分别为 94.0% 和 90.9%。结论。可以实施风险评分来检测谁可能面临严重不良后果的高风险，但所有接受 OPAT 的患者可能需要监测以预防或检测不良事件。
Background. Patients increasingly receive home-based outpatient parenteral antimicrobial therapy (OPAT). Understanding which patients might be at higher risk of complications is critical in effectively triaging resources upon and after hospital discharge.Methods. A prospective cohort of patients discharged from 1 of 2 academic medical centers in Baltimore, Maryland, between March 2015 and December 2018 were consented and randomly divided into derivation and validation cohorts for development of a risk score for adverse OPAT outcomes. Data from the derivation cohort with the primary outcome of a serious adverse outcome (infection relapse, serious adverse drug event, serious catheter complication, readmission, or death) were analyzed to derive the risk score equation using logistic regression, which was then validated in the validation cohort for performance of predicting a serious adverse outcome.Results. Of 664 patients in the total cohort, half (332) experienced a serious adverse outcome. The model predicting having a serious adverse outcome included type of catheter, time on OPAT, using a catheter for chemotherapy, using a catheter for home parenteral nutrition, being treated for septic arthritis, being on vancomycin, being treated for Enterococcus, being treated for a fungal infection, and being treated empirically. A score >= 2 on the serious adverse outcome score had a 94.0% and 90.9% sensitivity for having a serious adverse outcome in the derivation and validation cohorts, respectively.Conclusions. A risk score can be implemented to detect who may be at high risk of serious adverse outcomes, but all patients on OPAT may require monitoring to prevent or detect adverse events.