Fernandes P, et al. - An estimation was carried out of the rates of outpatient parenteral antimicrobial therapy (OPAT) antimicrobial- and intravenous access-related complications. Additionally, researchers contemplated their correlations with specific antimicrobials and type of intravenous access among pediatric patients. A link was brought to light between the use of oxacillin during OPAT with a higher rate of antimicrobial discontinuation (AD). Higher rates of unplanned outpatient visits were reported among patients treated with clindamycin and those with a peripherally inserted central catheter. Findings recommended strong consideration of alternative treatment options by the providers, whenever possible.

Methods

• The scheme of this research was an observational cohort study.
• Researchers analyzed patients receiving OPAT from August 2008 to May 2015 cared for by the Infectious Diseases service at a tertiary children’s hospital.
• Antimicrobial discontinuation (AD) because of OPAT-associated complications served as the primary outcome.
• Secondary outcomes constituted unplanned outpatient healthcare visits and readmissions from OPAT-associated complications.

Results

• This trial included the prescription of 707 intravenous antimicrobials for 540 cases.
• The most common diagnosis was disclosed to be the nondevice-associated musculoskeletal infection (39%).
• The antimicrobials that were most frequenly used were ceftriaxone (30%), cefazolin (27%) and vancomycin (22%).
• As per outcomes, complications resulted in AD, ≥1 unplanned outpatient healthcare visit and ≥1 readmission in 23%, 30% and 17% of cases, respectively.
• In comparison with the use of ceftriaxone, oxacillin use correlated with a substantially higher risk of AD because of any antimicrobial-related complication [hazard ratio (HR), 3.3; 95% confidence interval (CI): 1.2-9.7) and because of hepatic transaminitis (HR, 32.8; 95% CI: 4.02-268.2).
• A greater tendency for unplanned outpatient visits were reported among enrollees treated with intravenous clindamycin (HR, 2.6; 95% CI: 1.1-5.8) and with a peripherally inserted central catheter (HR, 2.6; 95% CI: 1.04-6.3).