For children discharged after hospitalization for serious bacterial infections, are orally administered antibiotics as effective as antibiotics given intravenously through a PICC?
Treatment failure rates were low overall, 3.2% among PICC antibiotic recipients and 2.6% among oral antibiotic recipients, and not significantly different between the groups in across-hospital matched analysis (risk difference, 1.8% [95% CI, −0.4% to 3.9%]). PICC complications, which occurred in 7.1...
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| Format: | eBook |
| Language: | English |
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Washington, DC
Patient-Centered Outcomes Research Institute
2018, [2018]
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| Series: | Final research report / Patient-Centered Outcomes Research Institute
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| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | Treatment failure rates were low overall, 3.2% among PICC antibiotic recipients and 2.6% among oral antibiotic recipients, and not significantly different between the groups in across-hospital matched analysis (risk difference, 1.8% [95% CI, −0.4% to 3.9%]). PICC complications, which occurred in 7.1% of children, included PICC thrombosis resulting in malfunction (n = 11) and PICC dislodgment or breakage (n = 4). The composite outcome of all revisits was higher among PICC antibiotic recipients (risk difference, 14.8% [95% CI, 10.1%-19.3%]). Of 4579 children with perforated appendicitis, 6.2% received intravenous antibiotics (range, 0%-81.5% per hospital). In the across-hospital (risk difference, 0.3% [95% CI, −0.1% to 2.5%]) and within-hospital (risk difference, 0.6% [95% CI, −0.2% to 3.0%]) matched analyses, children treated with antibiotics via the oral route (reference group) did not experience more treatment failures than those treated with antibiotics via the PICC route. Among the children in the PICC group, 158 (15.0%) had a PICC complication that required an emergency department visit (n = 96), a rehospitalization (n = 38), or both (n = 24). Thus, the PICC group had a higher risk of requiring a return visit to the emergency department or for hospitalization for any adverse outcome in across-hospital (risk difference, 14.6% [95% CI, 11.3%-17.9%]) and within-hospital (risk difference, 14.0% [95% CI, 10.5%-17.6%]) matched analyses. Among 2123 children with complicated pneumonia, 281 (13.2%) received antibiotics via PICC. BACKGROUND: Postdischarge treatment of acute osteomyelitis, complicated pneumonia, and perforated appendicitis in children require weeks of antibiotic therapy, which can be administered orally or intravenously via a peripherally inserted central catheter (PICC). These catheters carry a risk for serious complications, but limited evidence exists on the effectiveness of oral therapy. OBJECTIVES: To compare the effectiveness and adverse outcomes of postdischarge antibiotic therapy administered via a PICC or the oral route. METHODS: We performed 3 separate retrospective cohort studies comparing PICC and oral therapy for the postdischarge treatment of acute osteomyelitis, complicated pneumonia, and perforated appendicitis. The primary outcome was treatment failure within 6 months, 14 days, and 30 days, respectively. Secondary outcomes included adverse drug reaction, PICC line complication, and a composite of all 3 end points. In the across-hospital matched analysis, the rate of treatment failure was significantly higher for the PICC group than the oral group (9.2% vs 5.1% [odds ratio [OR], 1.74; 95% CI, 1.05-2.88; risk difference: 4.0%; 95% CI, 0.4%-7.6%]), as was the rate of all-cause revisits (19.8% vs 11.1% [OR, 2.11; 95% CI, 1.44-3.11; risk difference: 9.2%; 95% CI, 4.2%-14.1%]) and non-treatment-failure-related revisits (10.2% vs 6.8% [OR, 2.21; 95% CI, 1.33-3.70; risk difference: 5.4%; 95% CI, 2.0%-8.8%]). The rate of PICC line complications was 3.2%. CONCLUSIONS: Given the magnitude and seriousness of PICC complications, clinicians should reconsider the practice of treating otherwise healthy children with acute osteomyelitis, complicated pneumonia, and perforated appendicitis with prolonged intravenous antibiotics after hospital discharge when an equally effective oral alternative exists Among children hospitalized from January 1, 2009, through December 31, 2012, at 36 participating children's hospitals, we used discharge codes to identify potentially eligible participants. The results of a medical record review confirmed eligibility and defined treatment group allocation and study outcomes. We used within- and/or across-hospital propensity score-based full matching to adjust for confounding by indication. RESULTS: Among 2060 children and adolescents (herein after referred to as children) with osteomyelitis, 1005 received oral antibiotics at discharge, whereas 1055 received PICC-administered antibiotics. The proportion of children treated via the PICC route varied across hospitals from 0% to 100%. |
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