Blood tests during intravenous antimicrobial therapy at home (OPAT): Less frequent, more personalized

A recent Radboudumc study has explored the occurrence of laboratory abnormalities, such as liver enzyme elevation, kidney dysfunction, and anemia, in patients receiving intravenous antimicrobial therapy at home (OPAT). Despite the frequent appearance of these abnormalities, the study found they seldom lead to discontinuing OPAT.

Researchers Hester Stoorvogel, Jaap ten Oever, and colleagues from the Departments of Internal Medicine, Medical Microbiology, and IQ Health, in collaboration with several Dutch hospitals, examined the frequency and risk factors of these abnormalities. The findings, published in Journal of Infection on October 5, 2024, are the outcome of a multicenter cohort study involving 1,152 patients across four hospitals. 

The study identified abnormal liver function as the most frequent issue, while low potassium levels were the least observed. Specific patient, treatment and laboratory characteristics (e.g. type of intravenous antibiotics) were associated with the occurrence of laboratory abnormalities during OPAT.

Part of research team. From left to right: Marlies Hulscher, Hester Stoorvogel, Jaap ten Oever

Implications for Personalized Laboratory Monitoring

Current guidelines recommend weekly blood tests for OPAT patients but lack sufficient evidence on the optimal testing frequency. This study suggests that a more tailored approach may be effective, reducing unnecessary blood draws while maintaining safety. Notably, liver function tests might be reduced after the first 10 days, while kidney monitoring should be prioritized for patients on glycopeptides, flucloxacillin, or diuretics. Potassium monitoring, in contrast, was rarely required due to low incidence of hypokalemia.

Towards More Efficient Patient Care

These findings support a shift towards individualized laboratory testing, which could improve patient comfort by reducing the frequency of blood draws. The study’s results could prompt updates to OPAT monitoring protocols, enhancing patient care through a more evidence-based, patient-centered approach.

This research is part of Radboudumc Research program: Optimal infectious disease care and outbreak response

About the publication

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 Nov;89(5):106301. https://doi.org/10.1016/j.jinf.2024.106301