Characteristics and Outcomes of Outpatient Parenteral Antimicrobial Therapy at an Academic Children’s Hospital

Madigan, Theresa; Banerjee, Ritu

doi:10.1097/inf.0b013e31827ee1c2

Cited by 46 publications

(58 citation statements)

References 32 publications

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“…24 The use of a central line carries additional risk of a VAC in 28% of patients with a central line, with need to replace the line in 10.9%. [13][14][15]18,[20][21][22] The most common ADEs include neutropenia, rash, and diarrhea (consistent with other studies 21,23,24 ). Although our definition of neutropenia was nonsevere (ANC ,1500, at a level in which our clinic staff consider monitoring more closely), of the 84 patients who experienced neutropenia, 42% had an ANC in a range in which most practitioners would change the antimicrobial (200-499), and 11% had an ANC of ,200, where concern for opportunistic infection is greater.…”

Section: Discussionmentioning

confidence: 73%

“…11 Current literature supports that 19% to 51% of children experience adverse drug events (ADEs) and 27% to 41% experience venous access complications (VACs) while receiving OPAT. [12][13][14][15][16][17][18][19][20][21][22][23][24] Most studies, however, are limited in size, often exclude children with premorbid conditions, evaluate a single clinical diagnosis, and exclude patients treated with oral antibiotics. Because the Children' s Hospital Colorado (CHCO) treats patients with complex comorbidities and a wide variety of diagnoses by using both oral and parenteral agents, we use a term intended to encompass both: long-term antimicrobial therapy (LTAT).…”

mentioning

confidence: 99%

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Adverse Events in Pediatric Patients Receiving Long-term Oral and Intravenous Antibiotics

Murphy

Fenn

Pyle

et al. 2016

Hospital Pediatrics

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A B S T R A C T BACKGROUND AND OBJECTIVE: Children receiving long-term antibiotic therapy (LTAT) atChildren's Hospital Colorado (CHCO) are treated with both oral and intravenous (IV) agents and often experience complications not comprehensively described by the literature. We sought to describe adverse drug events (ADEs) and venous access complications (VACs) in pediatric patients managed with oral and IV antibiotics so as to inform clinical decision-making, drug monitoring, and patient counseling at CHCO. METHODS:We conducted a retrospective review of children receiving LTAT through the CHCO infectious disease service from 2006 to 2012. Demographic, microbiologic, diagnostic data, ADEs, and VACs were recorded for each patient.RESULTS: From 2006 to 2012, 521 patients received 1876 courses, accounting for 71 306 days of antimicrobial therapy. A total of 219 patients (42 %) developed an ADE with discontinuation of the offending agent in 65% of courses associated with an ADE. The most common ADEs were neutropenia, rash, and diarrhea. Central lines were placed in 376 patients with 106 (28%) experiencing $1 VACs. IV agents were associated with a fourfold increase in the rate of ADEs compared with oral agents, and a fivefold increase when VACs were included. CONCLUSIONS:Practitioners may make more informed decisions and risk assessments by using descriptive ADE information for specific agents and mode of drug delivery to mitigate risk, thereby improving the quality of care. Patients should be counseled regarding risks of LTAT, including increased risk with IV therapy, and actively monitored for side effects.

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Section: Discussionmentioning

confidence: 73%

mentioning

confidence: 99%

Adverse Events in Pediatric Patients Receiving Long-term Oral and Intravenous Antibiotics

Murphy

Fenn

Pyle

et al. 2016

Hospital Pediatrics

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“…Study populations varied from 56 to 4005. Treatments in these studies included those for infections in bone and joint, endovascular, soft tissue, respiratory, central nervous system and other minor infections . Details of these studies are given in Table .…”

Section: Resultsmentioning

confidence: 99%

“…Numerous studies assessing the adverse events (AEs) and effectiveness of HITH and OPAT have been performed in many countries including Australia, USA, UK, Spain, France, Singapore, Israel, Canada, Italy, Ireland, New Zealand, Saudi Arabia, Switzerland and Greece . Some studies have analysed the safety of HITH or OPAT for a particular disease or for a particular group including geriatric or paediatric patients …”

Section: Introductionmentioning

confidence: 99%

“…The studies used a number of indicators to study the safety and effectiveness of HITH or OPAT: cure or success rate; treatment failure rate; mortality rate; rate of complications with vascular access devices (VAD) including thrombosis, occlusion, removal, infection, phlebitis and bleeding; adverse drug reactions; unplanned telephone calls; unscheduled staff callouts; hospital readmission; treatment extension; and adverse events as defined by the Harvard Medical Practice Study—“the adverse event is an unplanned injury or complication caused by healthcare management which leads to disability, death or prolonged hospital stay.”…”

Section: Introductionmentioning

confidence: 99%

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Safety and effectiveness of ‘hospital in the home’ and ‘outpatient parenteral antimicrobial therapy’ in different age groups: A systematic review of observational studies

et al. 2018

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Antibiotic‐associated neutropenia is marked by the depletion of intestinal Lachnospiraceae and associated metabolites in pediatric patients

Fernandez‐Sanchez,

Rodgers,

Maknojia

et al. 2024

HemaSphere

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Prolonged antibiotic exposure causes dangerous hematologic side effects, including neutropenia, in up to 34% of patients. Murine studies established a link between the intestinal microbiota and hematopoiesis. To identify factors that predispose to neutropenia in pediatric patients, we evaluated changes in microbiota‐derived metabolites and intestinal microbiota composition after prolonged courses of antibiotics. In this multi‐center study, patients with infections requiring anticipated antibiotic treatment of two or more weeks were enrolled. Stool samples were obtained at the start and completion of antibiotics or at neutropenia onset (prospective arm). Some patients were enrolled in a retrospective arm in which a stool sample was collected at the time of neutropenia during antibiotic therapy and 2–4 weeks after completion of antibiotics with recovery of blood counts. We identified 10 patients who developed neutropenia on antibiotics and 29 controls matched for age, sex, race, and ethnicity. Clinical data demonstrated no association between neutropenia and the type of infection or antibiotic used; however, patients with neutropenia were admitted to the intensive care unit more often and received longer courses of antibiotics. Reduced intestinal microbiome richness and, specifically, decreased abundance of Lachnospiraceae family members correlated with neutropenia. Untargeted stool metabolomic profiling revealed several metabolites that were depleted exclusively in patients with neutropenia, including members of the urea cycle pathway, pyrimidine metabolism, and fatty acid metabolism that are known to be produced by Lachnospiraceae. Our study shows a relationship between intestinal microbiota disruption and abnormal hematopoiesis and identifies taxa and metabolites likely to contribute to microbiota‐sustained hematopoiesis.

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Characteristics and Outcomes of Outpatient Parenteral Antimicrobial Therapy at an Academic Children’s Hospital

Cited by 46 publications

References 32 publications

Adverse Events in Pediatric Patients Receiving Long-term Oral and Intravenous Antibiotics

Adverse Events in Pediatric Patients Receiving Long-term Oral and Intravenous Antibiotics

Safety and effectiveness of ‘hospital in the home’ and ‘outpatient parenteral antimicrobial therapy’ in different age groups: A systematic review of observational studies

Antibiotic‐associated neutropenia is marked by the depletion of intestinal Lachnospiraceae and associated metabolites in pediatric patients

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