SAN DIEGO – Oral antibiotic therapy should be the preferred postdischarge treatment for pediatric patients with complicated pneumonia, as peripherally inserted central catheter (PICC) treatment has higher rates of treatment failure, adverse drug reactions, and related revisits, according to Dr. Samir S. Shah.
“Pneumonia is important because it is costly; in terms of cumulative costs to children’s hospitals, it is the second-most costly condition,” explained Dr. Shah, director of the division of hospital medicine at the Cincinnati Children’s Hospital Medical Center, who presented the findings of this retrospective cohort study at the annual meeting of the Pediatric Academic Societies.
Dr. Samir S. Shah
“It is also potentially serious,” Dr. Shah continued. “Up to 15% of children hospitalized with pneumonia may have their course complicated by empyema, [and] even more problematic is that the incidences of complicated pneumonia are increasing.”
Dr. Shah and his coinvestigators examined the records for all children hospitalized between Jan. 1, 2009, and Dec. 31, 2012, with complicated pneumonia at 36 centers from across the United States. The primary outcome was treatment failure. Secondary outcomes were revisits related to the index admission, such as PICC complications, adverse drug reactions, and overall revisits.
The rate of treatment failure was higher in patients receiving PICC: 3.2% vs. 2.6% for those receiving oral antibiotics after discharge. Adverse drug reactions occurred in 3.2% of subjects receiving PICC, compared with only 0.2% of subjects in the oral antibiotics cohorts. Both related and overall revisits were higher in the PICC cohort than in the oral antibiotics cohort, too: 6.1% vs. 3.0% for related revisits, and 17.8% vs. 5.8% for overall revisits (P < .05). Treatment failure occurred in 49 children across both cohorts (2.3%).
Of the 2,123 children deemed eligible and included in the study, 281 were prescribed PICC as postdischarge treatment (13.2%), and the use of PICC overall varied from hospital to hospital; some centers prescribed PICC treatment in as many as 71% of cases, while some never prescribed it. Serum sickness, drug-induced neutropenia, and PICC thrombosis, dislodgment, and fever were the most commonly reported adverse effects across both cohorts. Treatment failure was reported in 49 (2.3%) cases.
“There were some problems with matching,” explained Dr. Shah, who is also professor of pediatrics at the University of Cincinnati. “Because many centers had small numbers of kids discharged with PICC therapy, we could not account for differences across hospitals.”
A review of charts’ ICD-9 codes in the nationwide Pediatric Health Information System (PHIS) and the Pediatric Research in Inpatient Settings (PRIS) Network was used to collect the patient population, and providers at each of the 36 institutions included reviewed medical records to confirm patient eligibility, define treatment groups, determine which antibiotic each patient was discharged with, and verify outcomes.
“This was an observational study, [and] there are limitations that go with that,” said Dr. Shah. “We adjusted for confounding using propensity score matching, but there are unmeasured confounding factors; [however,] because we matched across hospitals, we could better account for confounding by indication at the patient level.”
Dr. Shah did not report any relevant financial disclosures.