Over 25% of individuals with Lyme disease present with disseminated Lyme disease (DLD). Most manifestations of DLD can be treated with oral or parenteral regimens. Few data are available to define treatment complications of pediatric DLD. We aimed to describe treatment approaches and treatment-related complications in pediatric patients with DLD.
This is a retrospective cohort study of children <18 years admitted to an urban, tertiary care children's hospital in southeastern Pennsylvania with DLD from 2007-2014. Potential DLD cases were identified using ICD-9 codes and structured DLD case definitions that were verified by chart review. Patients who received >48 hours of Lyme-directed antibiotic therapy prior to admission were excluded. Inpatient and outpatient medical records, including phone call documentation, were reviewed from diagnosis of DLD to 6 weeks after hospital discharge for any treatment-related complications, including adverse drug reactions, central venous catheter (CVC) complications (e.g. CVC displacement, thrombosis, infection), and parent concerns. Data were analyzed with descriptive statistics.
Of 114 children admitted with DLD during the study period, 77 (68%) were male and 89 (78%) were ≥8 years old. Lyme arthritis (n=50) was the most common presentation (Figure 1). Approximately one-third of patients were treated with all parenteral therapy (n=37; 32%) or all oral therapy (n=41; 36%). Ten of 15 subjects with a treatment-related complication were receiving parenteral therapy. CVC complications occurred in 5 patients. Parent concerns were reported for 17 (15%) and 9 (8%) of patients receiving parenteral and oral therapy, respectively. Six subjects were rehospitalized due to treatment-related complications.
A significant number of children experienced treatment-related complications, with the majority of complications associated with parenteral therapy. Prioritizing the use of oral therapy when appropriate may contribute to improved outcomes among children with DLD.
S. Coffin, None
L. Handy, None