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Risk Factors for Adverse Events in Children Receiving Outpatient Parenteral Antibiotic Therapy
Elizabeth Townsley1, Jessica Gillon1, Natalia Jimenez-Truque1
1Vanderbilt University Medical Center, Nashville, Tennessee.
Insights
Outpatient parenteral antibiotic therapy (OPAT) in children leads to adverse events in 39% of cases, with central venous catheter issues more common than medication problems. Longer treatment duration and urban residence increase risks, emphasizing early oral antibiotic conversion.
Area of Science:
- Pediatric Infectious Diseases
- Pharmacology
- Patient Safety
Background:
- Outpatient parenteral antibiotic therapy (OPAT) reduces hospital stays but carries risks of adverse events (AEs).
- Understanding OPAT-associated AEs in pediatric populations is crucial for optimizing treatment.
- Identifying specific risk factors can improve patient outcomes and safety protocols.
Purpose of the Study:
- To quantify the incidence of adverse events (AEs) associated with outpatient parenteral antibiotic therapy (OPAT) in children.
- To identify demographic and clinical risk factors contributing to OPAT-associated AEs in pediatric patients.
- To inform strategies for mitigating AEs and improving the safety of pediatric OPAT.
Main Methods:
- Retrospective single-center study analyzing pediatric patients (≤21 years) on OPAT from January 2016 to April 2019.
- Chart review to collect data on demographic factors, clinical characteristics, and medication/central venous catheter (CVC)-associated AEs.
- Univariable and multivariable analyses were conducted to identify risk factors for OPAT-associated AEs.
Main Results:
- An AE occurred in 70 out of 181 (39%) OPAT courses.
- Medication AEs occurred in 16.6% of courses; urban residence was a significant risk factor (OR: 4.51).
- CVC AEs occurred in 26% of courses; each additional day of OPAT increased CVC AE risk by 4% (OR: 1.04).
- Eleven percent of OPAT courses resulted in hospital readmission due to AEs.
Conclusions:
- Nearly 40% of children experienced AEs during OPAT, with CVC complications being more frequent than medication-related issues.
- Prolonged OPAT duration and urban residency are independent risk factors for AEs.
- Transitioning to oral antibiotics promptly is essential to minimize OPAT-associated AEs in pediatric patients.
Background:
Outpatient parenteral antibiotic therapy (OPAT) can decrease length of hospital stay but is associated with adverse events (AEs). The purpose of this study was to quantify and identify risk factors for OPAT-associated AEs in children.
Methods:
Retrospective single-center study of children ≤21 years old discharged on OPAT from January 2016 to April 2019 with infectious diseases follow-up. Demographic and clinical factors and medication and central venous catheter (CVC)-associated AEs were assessed through chart review. Univariable and multivariable analyses were performed.
Results:
Among 181 OPAT courses, an AE occurred in 70 (39%). Medication AEs occurred in 30 of 181 courses (16.6%). Children residing in an urban area had a 4.5 times higher risk of having a medication-related AE compared with those in a rural area (odds ratio: 4.51; 95% confidence interval: 1.60-12.77; P = .005). CVC AEs occurred in 47 of 181 courses (26%). Every additional day of OPAT increased the odds of having a CVC-related AE by 4% (odds ratio: 1.04; 95% confidence interval: 1.01-1.07; P = .003). Twenty (11.1%) courses resulted in readmission to the hospital because of an AE.
Conclusions:
In this cohort, 39% of children experienced an OPAT-associated AE, and CVC AEs were more common than medication AEs. Longer duration of intravenous therapy and urban residence were independently associated with OPAT-associated AEs, highlighting the importance of converting to oral antibiotic therapy as soon as feasible to reduce OPAT-associated AEs.
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