J: Clinical Practice Issues
Oral Abstract Submission
Ritu Banerjee, MD, PhD
Vanderbilt University Medical Center
Disclosure: Accelerate Diagnostics: Grant/Research Support
BioFire: Research Grant
Biomerieux: Research Grant
Roche: Research Grant
Background : Outpatient parenteral antibiotic therapy (OPAT) can decrease length of hospital stay but is associated with adverse events (AEs). The purpose of this study is to quantify and identify risk factors for OPAT-associated AEs in children.
This is a retrospective, single-center study of pts ≤21 years old discharged on OPAT from Jan 2016 – Apr 2019. Only pts with OPAT overseen by the infectious disease service were included. Medication AE’s included: rash, neutropenia, hepatitis, diarrhea, C. difficile infection, increased serum creatinine, or other. Central line AEs included: central line dysfunction, infection, rash around line site, or other. Wilcoxon rank-sum test, Pearson’s Chi-squared test, Fisher’s exact test, and multivariable logistic regression models were used for analyses.
Results : Demographic information can be found in Table 1. Among 176 patients included in the study, an AE occurred in 69 (39%). In a multivariable logistic regression model adjusting for age, county of residence, duration of OPAT, and duration line was in place, each additional day of antibiotics increased the odds of having a medication or line-related AE by 3% (OR 1.03; 95% CI 1.01 – 1.06; p=0.005; Table 2). Medication AEs occurred in 30 pts (17%). The most frequent medication AEs were neutropenia (24%), rash (15%), and increased liver function tests (15%). Pts residing in a Large Fringe Metro area (suburb) had 33% lower odds of having a drug-related AE compared with those in a Large Central Metro area (OR 0.67; 95% CI 0.50 to 0.90; p=0.008). Line AEs occurred in 46 pts (26%), with 10 pts (21%) experiencing >1 line AE. The most common line AEs were line malfunction (56.5%) and line infection (13%). Seven pts experienced both a medication AE and a central line AE. Of the 176 patients, 20 (11%) were readmitted to the hospital due to medication or line AE and an additional 25 (14%) had a healthcare visit for an AE although did not require admission.
Conclusion : In our region, nearly 40% of children experienced an OPAT-associated AE and line AEs were more common than medication AEs. Longer durations of IV therapy was an independent risk factor for AEs. Converting to oral antibiotic therapy as soon as feasible may reduce OPAT-associated AEs.