Favorable Outcomes With Early Transition to Oral Antibiotics for Pediatric Osteoarticular Infections

2019 ◽  
Vol 58 (6) ◽  
pp. 696-699 ◽  
Author(s):  
Shamim Islam ◽  
Nora Biary ◽  
Brian Wrotniak
Keyword(s):  
Oral Antibiotics ◽  
Osteoarticular Infections ◽  
Early Transition

Outpatients with acute osteoarticular infections had favourable outcomes when they received just oral antibiotics without intravenous antibiotics

2018 ◽  
Vol 107 (10) ◽  
pp. 1792-1797 ◽  
Author(s):  
Rosa Alcobendas ◽  
Agustín Remesal ◽  
Sara Murias ◽  
Esmeralda Nuñez ◽  
Cristina Calvo
Keyword(s):  
Oral Antibiotics ◽  
Osteoarticular Infections ◽  
Intravenous Antibiotics

scholarly journals Variability in Management of Acute Osteoarticular Infections at a Children’s Hospital and Favorable Outcomes with Increasing Early Transition to Oral Therapy

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S93-S94
Author(s):  
Nora Biary ◽  
Brian Wrotniak ◽  
Shamim Islam
Keyword(s):  
Oral Therapy ◽  
Children's Hospital ◽  
Patient Demographics ◽  
Osteoarticular Infections ◽  
Improved Outcomes ◽  
Before And After ◽  
Children’S Hospital ◽  
Picc Line ◽  
Mean Time ◽  
Early Transition

Abstract Background To date, there is no established guideline for the treatment of acute pediatric osteoarticular infections (OAI), and considerable variability in management exists amongst providers and across institutions. This study analyzed the recent management and clinical outcomes of OAI at a children’s hospital. Methods Patients admitted with acute osteomyelitis and septic arthritis [OAI] aged 2 months to 18 years at the Women & Children’s Hospital of Buffalo, between 1/1/2013 and 12/31/2016, were identified via billing databases. Patients with select comorbidities or >2 positive blood cultures were excluded. Patient demographics, antibiotics used, culture results, time from intravenous (IV) to oral (PO) therapy, length of hospitalization (LOH), PICC (peripherally inserted central catheter) line use, and emergency room (ER) visits and readmissions within 6 months of discharge, were collected and analyzed. The study period was divided into 2-year groups, before and after 1/1/15, a juncture when a new provider began to promote early transition to oral therapy (through ID consults and informal discussion). Results Thirty-one patients were admitted during Time#1 (2013–14) and 43 during Time#2 (2015–16). Time to PO therapy was widely distributed (Figure 1) throughout the 4 years, with 65% of patients in Time#2 transitioned ≤7 days, vs. 37% in Time#1 (P = 0.02). Specifically for osteomyelitis, mean time to PO decreased from Time#1 to #2 from 11.5 to 8.3 days. Sixty-one percent of patients in Time#1 vs 25% in Time#2 (P < 0.01) received a PICC line, and PICC use was associated with 1.5 day greater LOH (P = 0.02). There was no relationship between time to PO and repeat ER visit/readmission. Nearly 30% of patients in Time#1 had PICC or OAI-related ER visits/readmissions after discharge, while 0% did for Time#2 (P < 0.01). Conclusion Length of initial IV therapy and PICC line use continues to vary significantly for pediatric acute OAI. In our children’s hospital, a shift towards earlier transition to PO therapy has been adopted steadily – and prior to national and planned local guidelines – with a general decrease in LOH, duration of IV therapy, PICC line issues following discharge, and overall improved outcomes. Pediatric OAI management represents an ideal focus for institutional quality and antibiotic stewardship efforts. Disclosures S. Islam, Qiagen: Speaker’s Bureau, Speaker honorarium and travel support

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