Methods: Retrospective observational study at a tertiary children’s hospital of patients discharged on IV vancomycin and followed by the infectious diseases service from August 2008-April 2016. We analyzed premature antimicrobial discontinuation (PAD) resulting from vancomycin-associated complications as the primary outcome and unplanned outpatient visits and readmissions as secondary outcomes. Potential risk factors for PAD were analyzed by multivariable logistic regression.
Results: 150 patients received OPAT with vancomycin. The median age and duration of therapy were 13.4 years (IQR 7.7-17.2) and 27.5 days (IQR 18-43), respectively. The most common diagnosis was non-device-associated musculoskeletal infection 49 (32.7%), and the most common pathogen was Staphylococcus aureus 45 (30%). PAD occurred in 41 (27.33%) subjects, most commonly due to rash (10, 6.7%), abnormal vancomycin levels (9, 6%) and leukopenia/neutropenia (7, 4.7%). Creatinine abnormalities led to PAD in 6 (4%) subjects. Unplanned outpatient visits occurred in 65 (44%) subjects and readmissions in 39 (26%) subjects. On multivariable regression analysis of pathogen, receipt of concomitant antimicrobials, and duration of IV vancomycin, subjects with coagulase-negative staphylococci had higher odds of PAD due to any cause (OR 3.2, 95% CI 1.0-10.2). The odds of PAD due to rash decreased with longer vancomycin duration (OR 0.94, 95% CI 0.88-0.99 for each 1-day increment).
Conclusion: Premature vancomycin discontinuation occurred most commonly due to rash and abnormal antimicrobial levels. Nearly half of the subjects had unplanned outpatient visits. Transition to oral antimicrobial alternatives should therefore be encouraged when possible.
A. Growdon, None
F. Bourgeois, None
H. Mahoney-West, None
C. Lachenauer, None
M. Nakamura, None