JAMA Intern Med

Vancomycin via midline catheters linked to higher complication rates in outpatient therapy

July 29, 2025

Study details. This retrospective cohort study analyzed data from 3,317 hospitalized patients in the Michigan Hospital Medicine Safety Consortium who received outpatient parenteral antimicrobial therapy (OPAT) via midline catheters between January 2017 and August 2024. Patients were followed for up to 30 days post-insertion. The study compared complication rates between those receiving vancomycin (n=597) vs. other antimicrobials (n=2,720). Primary outcome: major device complication, including catheter-related bloodstream infection (CRBSI) and catheter-related venous thromboembolism (CR-VTE).

Results. Vancomycin use was associated with significantly higher rates of major complications (4.5% vs. 0.8%; P<.001), including an eightfold increased risk of CRBSI (hazard ratio [HR], 8.00; 95% confidence interval [CI], 2.96–21.63) and a threefold increased risk of CR-VTE (HR 3.30; 95% CI, 1.52–7.16). Minor complications and device failure were also more frequent in the vancomycin group.

Clinical impact. The findings reinforce existing guidelines against using midline catheters for vancomycin in OPAT due to safety concerns. To enhance patient safety and outcomes, prioritize safer access options and evaluate alternatives when feasible.

Source:

Paje D, et al. (2025, July 21). JAMA Intern Med. Safety of Vancomycin Use Through Midline Catheters for Outpatient Parenteral Antimicrobial Therapy. https://pubmed.ncbi.nlm.nih.gov/40690240/