1454. Complications of Home Central Venous Catheters and Home-based Outpatient Parenteral Antimicrobial Therapy: A Prospective Study
Session: Poster Abstract Session: Antimicrobial Stewardship: Outpatient Parenteral Antibiotic Therapy
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • Poster IDWeek 2015.pdf (245.7 kB)
  • Background: Attention has been paid to preventing complications of central venous catheters (CVCs), such as catheter-associated bloodstream infections, among inpatients. However, we know little about outcomes and experiences among patients discharged with CVCs or on outpatient parenteral antimicrobial therapy (OPAT). 

    Methods: We are conducting a prospective cohort study of patients discharged with CVCs to determine these outcomes. Patients discharged with tunneled CVCs, peripherally-inserted central catheters (PICCs), and Midline catheters from two academic medical centers, one tertiary care and one community-based hospital, were consented in this IRB-approved study. Participants were surveyed over the telephone every other week for the duration their CVCs were in place. Questions about clinical and functional outcomes, adverse events, exposures in the home environment, and overall experience were asked in a structured interview. Charts were abstracted through 30 days after therapy completion. To examine rates of complications, descriptive statistics were used. 

    Results: Of 73 patients discharged between March and April 2015 with CVCs, 36 (49.3%) consented for the study. Most had PICCs (N=29, 80.6%) and were receiving OPAT (N=30, 83.3%). Four had a major catheter-related complication (11.1%: 2 had catheter dislodgement; 2 had catheter-associated venous thrombosis). Of patients on OPAT, 13 of 30 (43.3%) had side effects from an antimicrobial agent, and therapy was changed in 4 (30.8%) of these patients. Eleven (30.6%) were readmitted within a month of hospital discharge. Many had exposures to potential environmental risks in the home: 22 (61.1%) had pets, 4 (11.1%) worked in a garden, and 19 (52.8%) had prepared raw meat for cooking while a CVC was in place. 

    Conclusion: Patients with CVCs in the home have high rates of hospital readmissions, and many on OPAT had adverse side effects from their antimicrobial agents, although most of these side effects were mild. Many patients may be exposed to environmental risks that could impact complications such as infections. These data are preliminary and further study is needed. When counseling patients getting discharged home with CVCs, we should identify and discuss ways to limit potential risk factors.

    Sara Keller, MD, MPH, MSHP1, Sara Cosgrove, MD, MS, FIDSA, FSHEA1, Trish M. Perl, MD, MSc, FIDSA, FSHEA2, Kathleen Pulice, BS1, Mitra Gavgani, PharmD3, David Hirsch, RN3 and Deborah Williams, RN3, (1)Department of Medicine, Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, MD, (2)Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, (3)Pharmaquip Infusion Services, Johns Hopkins Home Care Group, Baltimore, MD

    Disclosures:

    S. Keller, None

    S. Cosgrove, None

    T. M. Perl, None

    K. Pulice, None

    M. Gavgani, None

    D. Hirsch, None

    D. Williams, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.