Home intravenous antimicrobial service--twelve months experience in Christchurch

To review the clinical practice and complications of the home intravenous antimicrobial service at Christchurch Hospital after twelve months of full operation.

Clinical and microbiological diagnoses, antimicrobial therapy, and complications of home intravenous antimicrobial therapy were entered prospectively on an Excel data base.

Of the 153 patients, 113 (74%) suffered from skin, soft tissue or bone and joint disease. A bacteriological diagnosis was made in 108 patients (71%). 119 patients were treated with the narrow spectrum agents--penicillin 20 (13%), flucloxacillin 55 (36%) and cephazolin 44 (29%). Ceftriaxone was used for treatment in fifteen (10%) patients. Peripherally inserted central catheters (PICC's) were used in 129 patients, midlines fifteen, peripheral angiocaths in eight, and a Portacath in one. An elastomeric infusion device was used in 80 patients and an infusion pump in 34. Complications developed in 31 (20%) patients including three infections and one jugular vein thrombosis. Fifteen patients (10%) were readmitted within one month of discharge.

The home intravenous therapy programme successfully used first line narrow spectrum agents initiated in hospital with avoidance of unnecessary broad spectrum agents. Complication rates were acceptable and likely to improve with experience in patient selection and provision of support services.