1482. Safety of Outpatient Parenteral Antimicrobial Therapy (OPAT) in Children
Session: Poster Abstract Session: Antimicrobial Stewardship: Pediatric and OPAT
Saturday, October 10, 2015
Room: Poster Hall

Background:

Pediatric outpatient parenteral antimicrobial therapy (OPAT) presents unique safety challenges due to factors such as different antimicrobial pharmacokinetics, distinct co-morbidities and special considerations for intravenous access management in children. Characterizing frequencies of complications is important to optimize laboratory monitoring and understand and minimize risks of this mode of therapy.

Methods:

Retrospective study at Boston Children's Hospital of patients discharged on OPAT and followed by the infectious diseases service. A random sample of all eligible cases from January 2008-April 2015 was examined. Demographic, clinical and laboratory data related to the OPAT course were collected, and rates and timing of the most common complications were determined.

Results:

195 patients had 252 OPAT courses with a median duration of 24 days (IQR 16-38.5).  The most common diagnoses were acute osteomyelitis, hardware-associated infections and intracranial infections. The overall frequency of complications leading to antimicrobial discontinuation was 16.3% (Table 1), with vancomycin associated with the highest frequency (19.6%). Complications led to 104 unscheduled healthcare visits (including 31 readmissions), with 42.3% of these due to intravenous access-related problems. Leukopenia/neutropenia was the most common complication leading to antimicrobial discontinuation (Table 1). Leukopenia/neutropenia occurred at greatest frequency later in the OPAT course, while rash was most common early in therapy (Figures 1, 2 and 3).

Conclusion:

Complications are common in pediatric OPAT, occurring in about 1 of 6 cases. Close clinical and laboratory monitoring is therefore warranted. Preventing intravenous access-related problems could reduce unplanned healthcare visits and associated healthcare costs and inconvenience to families.

Table 1. Frequency of complications causing antimicrobial discontinuation.

                                          

Cefazolin (50)

Ceftriaxone (61)

Vancomycin (46)

All antimicrobials (252)

Leukopenia/Neutropenia

2

2

0

8

Rash

4

1

2

4

Transaminitis

0

4

0

5

Other

2

2

7

24

All complications (percent of courses)

8 (16.0%)

9 (14.8%)

9 (19.6%)

41 (16.3%)

Figure 1.

Figure 2.

Figure 3.

Priyanka Fernandes, MBBS, Helen Mahoney-West, MS, RN, Catherine Lachenauer, MD and Mari Nakamura, MD, MPH, Division of Infectious Diseases, Department of Medicine, Boston Children's Hospital, Boston, MA

Disclosures:

P. Fernandes, None

H. Mahoney-West, None

C. Lachenauer, None

M. Nakamura, None

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