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Inpatient Observation After Transition From Intravenous to Oral Antibiotics
Tiffany L Stromberg1, Alexandra D Robison2, Jenna F Kruger2
1Lucile Packard Children's Hospital Stanford, Stanford, California; and tcericol@gmail.com.
Insights
Pediatric patients with skin and soft tissue infections often remain hospitalized for observation after switching from intravenous to oral antibiotics. This study identified factors influencing this observation period, highlighting significant hospital-to-hospital variability.
Area of Science:
- Pediatric Infectious Diseases
- Hospital Medicine
- Antibiotic Stewardship
Background:
- Children hospitalized for infections are frequently transitioned from intravenous (IV) to oral (per os [PO]) antibiotics before discharge.
- In-hospital observation is common to ensure tolerance of PO therapy and clinical improvement.
- The frequency and predictors of this observation period in pediatric skin and soft tissue infections (SSTIs) are not well-described.
Purpose of the Study:
- To determine the frequency of in-hospital observation after transitioning from IV to PO antibiotics in children hospitalized for SSTIs.
- To identify predictors associated with in-hospital observation in this pediatric population.
Main Methods:
- Retrospective cohort study using the Pediatric Health Information System database (January 2016 - June 2018).
- Inclusion of children hospitalized for SSTIs.
- Classification of patients as observed if hospitalized ≥1 day post-IV to PO antibiotic transition.
- Logistic regression analysis to identify predictors of observation.
Main Results:
- 15% of pediatric SSTI hospitalizations involved ≥1 day of observation after IV to PO antibiotic transition.
- Significant variation in observation rates (4%-27%) was observed across different hospitals (P < .001).
- Older children were less likely to be observed (aOR=0.69), while those prescribed vancomycin (aOR=1.36) or with neck infections (aOR=1.72) were more likely to be observed.
Conclusions:
- In-hospital observation after IV to PO antibiotic transition is common in pediatric SSTIs, with considerable inter-hospital variability.
- Factors such as age, initial antibiotic choice (vancomycin), and infection site (neck) predict the duration of observation.
- Further research is warranted to optimize care and reduce unnecessary hospital stays for these patients.
Objectives:
Children hospitalized with infections are commonly transitioned from intravenous (IV) to enteral (per os [PO]) antibiotics before discharge, after which they may be observed in the hospital to ensure tolerance of PO therapy and continued clinical improvement. We sought to describe the frequency and predictors of in-hospital observation after transition from IV to PO antibiotics in children admitted for skin and soft tissue infections (SSTIs).
Methods:
We conducted a retrospective cohort study of children with SSTIs discharged between January 1, 2016, and June 30, 2018, using the Pediatric Health Information System database. Children were classified as observed if hospitalized ≥1 day after transitioning from IV to PO antibiotics. We calculated the proportion of observed patients and used logistic regression with random intercepts to identify predictors of in-hospital observation.
Results:
Overall, 15% (558 of 3704) of hospitalizations for SSTIs included observation for ≥1 hospital day after the transition from IV to PO antibiotics. The proportion of children observed differed significantly between hospitals (range of 4%-27%; P < .001). Observation after transition to PO antibiotics was less common in older children (adjusted odds ratio [aOR] = 0.69; 95% confidence interval [CI] 0.52-0.90; P = .045). Children initially prescribed vancomycin (aOR = 1.36; 95% CI 1.03-1.79; P = .032) or with infections located on the neck (aOR = 1.72; 95% CI 1.32-2.24; P < .001) were more likely to be observed.
Conclusions:
Children hospitalized for SSTIs are frequently observed after transitioning from IV to PO antibiotics, and there is substantial variability in the observation rate between hospitals. Specific factors predict in-hospital observation and should be investigated as part of future studies aimed at improving the care of children hospitalized with SSTIs.
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