Long-Term Self-Administered Outpatient Parenteral Antimicrobial Therapy in the Treatment of Tuberculosis.

Dec 30, 2024

Experts: A Rauch,N Köhler,T T Brehm,N Zielinski,K Stoycheva,C Maier,L Böttcher,I Friesen,D Schaub,M Reimann,S Schmiedel,C Lange,B Kalsdorf

To investigate the safety profiles and clinical outcomes in a continuous cohort of tuberculosis (TB) patients from a clinical referral centre in Germany receiving self-administered outpatient parenteral antimicrobial therapy (sOPAT).
We conducted a retrospective observational cohort study of patients receiving sOPAT after discharge from the Research Center Borstel in Germany between January 2015 and December 2020. Data were extracted from medical records.
In the observation period, 150 patients received parenteral antibiotics at the Research Center Borstel. Of these, 89 received sOPAT via a port catheter and were further analysed. The majority were male (n = 59, 66.3%), with a median age of 33.6 years (interquartile range-IQR 26.2-42.8). Most patients had multidrug-resistant (MDR)-TB (n = 56, 62.9%) or pre-extensively drug resistant (pre-XDR)-TB (n = 21; 23.6%). Fifty-eight (65.2%) patients received one and 24 patients (27.0%) received two parenteral drugs, most commonly capreomycin (n = 53, 59.6%) and meropenem (n = 44, 49.4%). The median duration of sOPAT was 7.4 months (IQR 5.2-17.2). In total, 71,128 intravenous drug administrations were recorded. One patient died of TB while another patient was lost to follow-up. Sixty-two (69.7%) patients completed the sOPAT regimen, the most common reason for premature discontinuation was adverse drug events (n = 12, 13.5%). There were eight (9.0%) port-related complications requiring port explantation (bloodstream infections: n = 6, local infection: n = 1, port thrombosis: n = 1).
In selected patients requiring long-term intravenous anti-TB therapy, sOPAT is a feasible treatment option with a low risk of complications when adequate infrastructure and training are in place.

© 2024. The Author(s).

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ABOUT THE EXPERTS

A Rauch,N Köhler,T T Brehm,N Zielinski,K Stoycheva,C Maier,L Böttcher,I Friesen,D Schaub,M Reimann,S Schmiedel,C Lange,B Kalsdorf

A Rauch

Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.

German Center for Infection Research (DZIF), Partner Site Borstel-Hamburg-Lübeck-Riems, Borstel, Germany.

Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany.

N Köhler

Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany. nkoehler@fz-borstel.de.

German Center for Infection Research (DZIF), Partner Site Borstel-Hamburg-Lübeck-Riems, Borstel, Germany. nkoehler@fz-borstel.de.

Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany. nkoehler@fz-borstel.de.

Division of Infectious Diseases, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. nkoehler@fz-borstel.de.

T T Brehm

Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.

German Center for Infection Research (DZIF), Partner Site Borstel-Hamburg-Lübeck-Riems, Borstel, Germany.

Division of Infectious Diseases, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

N Zielinski

Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.

German Center for Infection Research (DZIF), Partner Site Borstel-Hamburg-Lübeck-Riems, Borstel, Germany.

Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany.

K Stoycheva

Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.

German Center for Infection Research (DZIF), Partner Site Borstel-Hamburg-Lübeck-Riems, Borstel, Germany.

Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany.

C Maier

Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.

German Center for Infection Research (DZIF), Partner Site Borstel-Hamburg-Lübeck-Riems, Borstel, Germany.

Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany.

L Böttcher

Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.

German Center for Infection Research (DZIF), Partner Site Borstel-Hamburg-Lübeck-Riems, Borstel, Germany.

Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany.

I Friesen

National and WHO Supranational Reference Laboratory for Mycobacteria, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.

D Schaub

Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.

German Center for Infection Research (DZIF), Partner Site Borstel-Hamburg-Lübeck-Riems, Borstel, Germany.

Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany.

M Reimann

Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.

German Center for Infection Research (DZIF), Partner Site Borstel-Hamburg-Lübeck-Riems, Borstel, Germany.

Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany.

S Schmiedel

German Center for Infection Research (DZIF), Partner Site Borstel-Hamburg-Lübeck-Riems, Borstel, Germany.

Division of Infectious Diseases, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

C Lange

Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.

German Center for Infection Research (DZIF), Partner Site Borstel-Hamburg-Lübeck-Riems, Borstel, Germany.

Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany.

Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA.

B Kalsdorf

Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.

German Center for Infection Research (DZIF), Partner Site Borstel-Hamburg-Lübeck-Riems, Borstel, Germany.

Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany.

Pulmonary Care Center, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.