1481. Antimicrobial Regimen and Safety of Pediatric Outpatient Treatment in a Physician Office Infusion Center (POIC)
Session: Poster Abstract Session: Antimicrobial Stewardship: Pediatric and OPAT
Saturday, October 10, 2015
Room: Poster Hall
  • IDWeek 2015_Pediatrics Poster #1481_Nathan et al.pdf (934.9 kB)
  • Background: Treatment of pediatric infections through outpatient parenteral antimicrobial therapy (OPAT) is increasing, however, data on management and clinical outcomes are limited. This study describes OPAT in pediatric patients (peds) admitted to a POIC including clinical outcomes and safety for a variety of diagnoses.

    Methods: A retrospective multi-center (n=20) review was conducted of peds ≤ 18 years (n=64) treated for infection at a POIC from 1-2013 to 12-2014. Data collected included demographics, co-morbidities, cultures, drug regimen, adverse events, emergency department (ED) visits, hospital admissions and clinical outcomes. Clinical success was defined as cure or improvement at end of therapy.

    Results: Sixty four peds were admitted to a POIC over 2 years (yrs) for OPAT. Mean age was 16 yrs (range 6 -18), with 61% males (n=39). Co-morbidities were infrequent with 32 peds (50%) having none and 16 (25%) having one. Forty-two peds (66%) had prior hospitalization, whereas 22 peds (34%) had OPAT initiated in the POIC. Most frequent diagnoses included cellulitis with abscess (n=18), osteomyelitis (n=11), complicated intra-abdominal infection (n=9), infectious arthritis (n=6), meningitis (n=5) and postoperative wound infection (n=3). Most common OPAT included cefazolin (n=8), cefepime (n=2), cefotaxime (n=2), ceftriaxone (n=19), daptomycin (n=8), ertapenem (n=9), imipenem/cilastatin (n=5), piperacillin/tazobactam (n=6), and vancomycin (n=10). Seventeen (27%) peds received more than one OPAT in combination or sequentially. Mean duration of therapy was 17 days (range 1-56). Six peds (9%) required ED visits, but only 1 (2%) required catheter removal. Two peds required hospital admission. Adverse events occurred in 21 peds (33%) including diarrhea (n=5), itching (n=4), rash (n=3), neutropenia (n=2), thrombocytopenia (n=1) and drug-induced hepatitis (n=1). Thrombocytopenia, neutropenia, and hepatitis were managed by drug alteration and all patients completed therapy. Clinical success was achieved in 64 peds (100%) with 50 peds (78%) cured and 14 peds (22%) improved.

    Conclusion: Based on this 2-year study, use of POIC for the treatment of pediatric infections using various OPAT regimens was a safe and effective option. The incidence of adverse events remained low and treatments were well-tolerated in this population.

    Ramesh V. Nathan, MD1, Brian Metzger, MD, MPH2, Jorge R. Bernett, MD3, Richard C. Prokesch, MD, FACP, FIDSA4, Quyen Luu, MD5, Kimberly Couch, PharmD, MA, FIDSA, FASHP6 and Claudia P. Schroeder, PharmD, PhD6, (1)Mazur, Statner, Dutta, Nathan, PC, Thousand Oaks, CA, (2)Austin Infectious Disease Consultants, Austin, TX, (3)Infectious Disease Doctors Medical Group, Walnut Creek, CA, (4)Infectious Diseases Associates, Riverdale, GA, (5)Quyen Luu, MD, Macon, GA, (6)Healix Infusion Therapy, Inc., Sugar Land, TX


    R. V. Nathan, Cubist/Merck: Speaker's Bureau , Speaker honorarium

    B. Metzger, Cubist/Merck: Speaker's Bureau , Speaker honorarium
    Forest/Actavis: Speaker's Bureau , Speaker honorarium

    J. R. Bernett, None

    R. C. Prokesch, None

    Q. Luu, None

    K. Couch, Cubist/Merck: Speaker's Bureau , Speaker honorarium

    C. P. Schroeder, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.