Outpatient Parenteral Antibiotic Treatment (OPAT) in Pediatric Medicaid Enrollees
Background: OPAT has been used for nearly 40 years to treat a variety of infections in children. However, evidence demonstrates that OPAT is overused for certain diagnoses (e.g. osteoarticular infections) or antibiotics (e.g. clindamycin) when oral therapy would be appropriate. This may lead to unnecessary costs and complications including emergency department (ED) visits and hospital readmissions.
Objective: Describe the diagnoses treated and antimicrobials used for OPAT and the frequency of medical encounters associated with OPAT in a large population of pediatric Medicaid enrollees.
Methods: We analyzed 2009-2011 data from the Truven MarketScan® Medicaid claims database. MarketScan® contains claims data for inpatient and outpatient services, retail prescription drug services, and enrollment information for 6 million Medicaid enrollees from 12 de-identified states. OPAT inclusion criteria required an enrollee to be ≤18 years of age, have an outpatient claim with a healthcare common procedure coding system (HCPCS) code indicating home infusion therapy (S9494, S9497, S9500-504), and either i) a concomitant HCPCS code indicating antibiotic use or ii) a concomitant retail pharmacy fill for an intravenous antibiotic. We defined a medical encounter as a hospital readmission or ED visit occurring during an OPAT episode. We used descriptive statistics to characterize patient demographics, diagnoses, antimicrobials and medical encounters.
Results: We identified 1,373 OPAT episodes for 1,165 patients; 11% of patients had ≥2 episodes. Fifty-four percent of patients were male, and 12% were < 1 year of age. The most common diagnoses were gastrointestinal conditions (19%) and osteoarticular infections (18%). The most common antimicrobials were ceftriaxone (26%), vancomycin (21%) and clindamycin (9%). Twenty-seven percent of patients had a medical encounter during the OPAT course (13% ED, 14% readmission). Among patients with osteoarticular infections, the most common agent used for OPAT was clindamycin.
Conclusion: For many conditions where OPAT is used, oral therapy could be considered as an alternative. The high rate of medical encounters in this cohort underscores the need for greater scrutiny of pediatric OPAT use through stewardship.
J. Newland, None
B. Lee, None
J. S. Gerber, None
M. Hall, None
M. Kronman, None
A. L. Hersh, None