Risk Factors for Adverse Events in Children Receiving Outpatient Parenteral Antibiotic Therapy

Abstract

BACKGROUND: Outpatient parenteral antibiotic therapy (OPAT) can decrease length of hospital stay but is associated with adverse events (AEs). The purpose of this study was to quantify and identify risk factors for OPAT-associated AEs in children. METHODS: Retrospective single-center study of children ≤21 years old discharged on OPAT from January 2016 to April 2019 with infectious diseases follow-up. Demographic and clinical factors and medication and central venous catheter (CVC)–associated AEs were assessed through chart review. Univariable and multivariable analyses were performed. RESULTS: Among 181 OPAT courses, an AE occurred in 70 (39%). Medication AEs occurred in 30 of 181 courses (16.6%). Children residing in an urban area had a 4.5 times higher risk of having a medication-related AE compared with those in a rural area (odds ratio: 4.51; 95% confidence interval: 1.60–12.77; P = .005). CVC AEs occurred in 47 of 181 courses (26%). Every additional day of OPAT increased the odds of having a CVC-related AE by 4% (odds ratio: 1.04; 95% confidence interval: 1.01–1.07; P = .003). Twenty (11.1%) courses resulted in readmission to the hospital because of an AE. CONCLUSIONS: In this cohort, 39% of children experienced an OPAT-associated AE, and CVC AEs were more common than medication AEs. Longer duration of intravenous therapy and urban residence were independently associated with OPAT-associated AEs, highlighting the importance of converting to oral antibiotic therapy as soon as feasible to reduce OPAT-associated AEs.

Outcome and complications of outpatient parenteral therapy in pediatric emergency utilizing only peripheral vascular access

“…34 This study is the largest utilizing only peripheral vascular access compared to other studies where CVCs were used. 6,30,31 Our study supported previous ones that showed this service is possible and achievable with no serious adverse effects. We provided the first IV dose in the PED and then discharged the patient with a "capped" IV catheter and instructions to come back to a specific area in the ED for the subsequent doses of IV antibiotics and safety reassessment.…”

“…We consider the total number of patients in our study relatively high compared to other series. [28][29][30][31][32] The OPT unit is in the same building of the main PEC but managed by medical and nursing team independent of the PEC coverage. Therefore, almost 90% of the patients who were referred to the OPT unit were from the main PEC, and the remaining were from PEC satellites or other institutional EDs with no patients from the hospital wards.…”

“…9 In our study, we had a lower complication rate than other reported studies. 29,30,32 Complications were mainly in the vascular access, but the majority were managed by only one-time cannula reinsertion, and only 0.5% needed a change in treatment because of vascular issues. The complication rate in young infants was significantly less than that in older infants and children.…”