Personalized monitoring for laboratory abnormalities during home administration of antibiotics by infusion (OPAT)

Laboratory abnormalities during home administration of antibiotics by infusion (OPAT) are fairly common but rarely lead to OPAT discontinuation. Also, several patient and treatment factors are associated with the occurrence of these laboratory abnormalities. The researchers recommend a more personalized laboratory monitoring policy with fewer blood draws after conducting this multicenter cohort study, which is part of the PhD program of Hester Stoorvogel (Internal Medicine and IQ Health).

Current guidelines recommend weekly monitoring of blood values during OPAT. However, there is no good rationale for recommending this weekly frequency. It is thus quite possible that this frequency could be reduced, which would be more comfortable for the patient and save costs.

A recent study at four hospitals looked at how often and when laboratory abnormalities occur and whether any factors are associated with the occurrence of these abnormalities. Nearly half of the 1152 patients in this cohort had at least one laboratory abnormality during OPAT treatment, with liver abnormalities occurring most frequently. OPAT was rarely discontinued due to the occurrence of these laboratory abnormalities. Factors associated with the occurrence of this abnormality were type of antibiotic, comedication and patient factors such as gender and comorbidity.

Even though laboratory abnormalities occurred quite frequently, they were not often the reason for stopping OPAT treatment. Also, more is now known about predictive factors for laboratory abnormalities. Therefore, the researchers recommend a laboratory monitoring policy that is more tailored to the individual patient and is likely to lead to fewer blood draws.

These insights come from the research that is part of the PhD program of Hester Stoorvogel (Internal Medicine and IQ Health). Marlies Hulscher and Reinier Akkermans of IQ Health also contributed to this research.

Stoorvogel HH, van Egmond M, Wertheim HFL, Schouten JA, Hulscher MEJL, Peeters L, Kiers Y, Koenders S, Sprong T, van Mens SP, Tromp M, Richel O, Akkermans R, Ten Oever J. Occurrence and predictors of laboratory abnormalities during outpatient parenteral antimicrobial therapy – A multicenter cohort study to inform laboratory test monitoring. J Infect. 2024 Sep 30;89(5):106301. https://doi.org/10.1016/j.jinf.2024.106301