Outcomes of a Multidisciplinary Pediatric Outpatient Parenteral Antimicrobial Therapy (OPAT) Program at a Tertiary Children’s Hospital

Abstract Corresponding Author: Zachary Howe, 705 Riley Hospital Drive SFT Room W6111, Indianapolis, IN 46228, 317-948-9562, [email protected] No conflicts of interest Background Characteristics of pediatric outpatient parenteral antimicrobial therapy (OPAT) are not well described, and multidisciplinary programs are relatively rare. The primary aim of this study was to describe specific OPAT use, commonly encountered barriers, and clinical outcomes in patients from a newly established OPAT program at a tertiary children’s hospital. Methods A multidisciplinary OPAT program was established at Riley Hospital for Children in December 2021. Inpatient services were gradually included until all services were enrolled as of March 2023. Medical record data related to patient selection, the chosen antimicrobial regimen, and safety/efficacy outcomes were prospectively collected for patients completing OPAT during the year after go-live with all services (March 2023-February 2024). Results Among 90 OPAT courses during the study period, CNS and central line infections were the most common indications (30.0% and 34.4%, respectively). The most common interventions made by the OPAT pharmacist were changes in dose (30.0%), frequency (32.2%), and agent selection (56.7%) with a median of 3 interventions being made per patient (IQR 4). The most frequent IV antimicrobials utilized were ceftriaxone (25.6%) and vancomycin (12.2%), and the most reported adverse effects were acute kidney injury (5.6%) and neutropenia (ANC<1000 cells/mm3; 4.4%). Eighteen percent of cases were re-hospitalized during their OPAT course, most frequently due to reasons unrelated to their infection (33.3%) or due to need for another source control procedure (33.3%). There was no difference in likelihood of readmission between patients with and without home nursing care (53.3% vs 46.7%, p=0.35). Modifications to original OPAT treatment plans were noted in 12.2% of cases, and patients received IV antimicrobials for a median of 19 days (IQR 34 days). Conclusion Multidisciplinary pediatric OPAT programs are rare but have the potential to optimize antimicrobial selection and provide more structured monitoring and patient follow-up. Studies with larger cohorts of patients are needed to fully elucidate necessary resources that will overall enhance OPAT care and improve patient outcomes.