Researchers at Aarhus University Hospital Skejby in Denmark recently reported new data regarding complications in outpatient parenteral antimicrobial therapy (OPAT) for effective treatment of pulmonary bacterial infections in cystic fibrosis (CF) patients. The study was published in the journal BMC Infectious Diseases and is entitled “Outpatient parenteral antimicrobial therapy (OPAT) in patients with cystic fibrosis.”
CF is a rare, life-threatening genetic disease in which a defective gene (CFTR) induces a salt imbalance, causing the body to form unusually thick, sticky mucus that can obstruct the airways and promote dangerous lung infections, resulting in serious respiratory and also gastrointestinal manifestations. Bacteria such as Staphylococcus aureus, Haemophilus influenza and Pseudomonas aeruginosa can induce chronic pulmonary infections and a serious inflammatory response. Mortality among CF patients is usually caused by respiratory failure. There is no cure for the disease and it is estimated that almost 75,000 individuals worldwide suffer from CF, including 30,000 individuals in the United States alone.
Effective treatment of the pulmonary infections has been shown to significantly reduce lung function decline and increase the patient’s life expectancy. Antibiotics are an effective treatment for bacterial infection; however, the treatment itself can last up to 21 days to ensure the maximal reduction in pulmonary bacterial load. OPAT is an option that allows patients to return home quicker and to continue their daily life, with the antibiotic therapy being provided at home, in an office-based setting, or through a hospital-based infusion program. The OPAT strategy also reduces the risk of bacteria transmission among CF patients. However, for the OPAT strategy to be successful, patients have to receive the correct amount of antibiotics at the right time in order to avoid adverse reactions.
The goal of the study was to investigate the frequency of complications associated with OPAT, during and after treatment, when using catheters through a peripheral intravenous line or central lines (large veins, including the vena cava) among CF patients. The team conducted a retrospective review on data from CF patients followed at the Cystic Fibrosis Center West at Aarhus University Hospital in Denmark. All patients also underwent an interview.
A peripheral intravenous line was used in 64 cases, with 51 (79.7 %) employing bolus injection, where the antibiotics are provided in discrete amounts, and 13 (20.3 %) using an infusion pump, which allows a continuous administration of the antibiotics. Researchers found that the median life-time of peripheral venous lines before it needs to be replaced is 7 days when using an infusion pump and 5 days when using a bolus injection. The authors suggest that this indicates a more constant flow of antibiotics as provided by the infusion pump might be less traumatic for the vein. Furthermore, 27 out of the 51 (53.0 %) bolus injection cases lead to complications that required removal of the intravenous line. No complications were reported in infusion pump treatments.
Regarding central intravenous lines through PICC-lines (peripherally inserted central catheter-lines), researchers found that although the life-time of these lines has been reported to be up to 6 months, 39.1% (9 out of 23) of the cases employing PICC-lines in the study needed to be removed after a median life-time of 17 days due to complications. Nonetheless, the majority of the patients did not experience complications during the actual OPAT. Concerning PAC (port-a-cath) lines, researchers suggested that it can be considered a long-term solution as it was found to have a median life-time of at least 735 days. In total, 11 out of 26 PACs implanted (42.3 %) were removed due to complications.
The research team concluded that when considering peripheral venous line for OPAT, the use of an infusion pump minimizes complications. Regarding central lines, the team reports that PICC-lines and PACs have a similar frequency of complications that lead to catheter removal, although PACs have a considerably longer average life-time. The authors also report that allergic reactions were not observed during the treatments and that patients were overall pleased with the option of performing OPAT. Improvements in the procedure and line insertions can, however, still be made. These new insights give physicians and specialists treating CF patients with outpatient parenteral antimicrobial therapy a new set of best practices to maximize treatment efficacy and safety.
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