Catheter- and Antibiotic-Related Complications of Ambulatory Intravenous Antibiotic Therapy for Chronic Refractory Rhinosinusitis

Abstract

Background Chronic rhinosinusitis has several features of a prolonged bacterial infection including positive bacterial cultures and abnormal computed tomography findings such as mucosal thickening and hyperostotic bone. Recent studies have suggested that chronic rhinosinusitis may be treated successfully by outpatient parenteral antibiotic treatment (OPAT). In this setting, antibiotics are administered through a peripherally inserted central catheter (PICC). This study evaluates complications arising from OPAT for chronic rhinosinusitis. Methods A chart review was performed of 177 patients who underwent OPAT for chronic rhinosinusitis. Results PICC line–related infections (4/177, 2%)) included line thrombosis in three patients and septicemia in one patient. In the three patients with line thrombosis, the PICC lines were removed and replaced, allowing for completion of the antibiotic course. Antibiotic complications (29/177, 16%) included four patients with transient neutropenia and one patient with elevated liver function tests. Of the four patients with neutropenia, only one required a change in antibiotics. The patient with elevated liver function tests did not require a change in antibiotics. Minor complications from antimicrobial treatment such as rash, itchiness, flushing, and diarrhea were reported by 25 patients, 9 of these patients required a change in antibiotics. There were no permanent complications or deaths in this study. Conclusion Intravenous antimicrobial treatment administered through a PICC line in an outpatient setting is well-tolerated for chronic rhinosinusitis. Although PICC line and antibioticrelated complications are relatively infrequent, the physician should be aware of these complications and consider them in selecting patients for OPAT.