How safe is outpatient parenteral antimicrobial therapy in children?

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We aimed to determine rates of OPAT antimicrobial- and intravenous-access-related complications and their associations with specific antimicrobials and type of intravenous access in pediatric patients” Fernandes et al (2017).

Abstract:

BACKGROUND AND OBJECTIVE: Outpatient parenteral antimicrobial therapy (OPAT) provides numerous benefits but may pose unique risks in children. We aimed to determine rates of OPAT antimicrobial- and intravenous-access-related complications and their associations with specific antimicrobials and type of intravenous access in pediatric patients.

METHODS: Observational cohort study of patients receiving OPAT from 8/2008 to 5/2015 cared for by the Infectious Diseases service at a tertiary children’s hospital. Primary outcome was antimicrobial discontinuation (AD) due to OPAT-associated complications. Secondary outcomes were unplanned outpatient healthcare visits and readmissions from OPAT-associated complications.

RESULTS: 707 intravenous antimicrobials were prescribed in 540 cases. Non-device-associated musculoskeletal infection was the most common diagnosis (39%). Ceftriaxone (30%), cefazolin (27%) and vancomycin (22%) were the most commonly used antimicrobials. Complications led to AD, ≥1 unplanned outpatient healthcare visit, and ≥1 readmission in 23%, 30% and 17% of cases, respectively. Compared with use of ceftriaxone, use of oxacillin was associated with a significantly higher risk of AD due to any antimicrobial-related complication (hazard ratio [HR] 3.3, 95% confidence interval [CI] 1.2-9.7) and due to hepatic transaminitis (HR 32.8, 95% CI 4.02-268.2). Subjects treated with intravenous clindamycin (HR 2.6, 95% CI 1.1-5.8) and with a peripherally inserted central catheter (PICC) (HR 2.6, 95% CI 1.04-6.3) were more likely to have unplanned outpatient visits.

CONCLUSIONS: Use of oxacillin during OPAT was associated with higher rate of AD. Patients treated with clindamycin and those with a PICC had higher rates of unplanned outpatient visits. Providers should strongly consider alternative treatment options when possible.

Reference:

Fernandes, P., Milliren, C., Mahoney-West, H.M., Schwartz, L., Lachenauer, C.S. and Nakamura, M.M. (2017) Safety of Outpatient Parenteral Antimicrobial Therapy in Children. The Pediatric Infectious Disease Journal. July 31st. [Epub ahead of print].

doi: 10.1097/INF.0000000000001716.

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