Researchers from multiple institutions conducted a retrospective cohort study using data from the Pediatric Health Information System (PHIS) to compare the effectiveness and treatment-related complications of antibiotics delivered orally or through a peripherally inserted central venous catheter (PICC) after discharge among children with complicated pneumonia. Children were eligible if they were ≥2 months and <18 years old and were discharged between 2009 and 2012 from a PHIS-affiliated hospital with complicated pneumonia, defined as an ICD-9 discharge diagnosis code for both pneumonia and pleural effusion.
The main exposure was the route of antibiotic administration at discharge. This was determined by medical record review and classified as PICC or oral. If a PICC was placed during the index hospitalization but removed before discharge and the child was prescribed oral antibiotics at discharge, the child was classified as receiving oral therapy. The main outcome was treatment failure, defined as an emergency department (ED) revisit or rehospitalization that resulted in extension or change of antibiotic therapy or drainage of pleural fluid. Secondary outcomes included PICC complications (eg, PICC insertion site or bloodstream infection, PICC thrombosis resulting in malfunction) and adverse drug reactions (eg, diarrhea, Clostridium difficile infection, rash, erythema multiforme, anaphylaxis, drug fever). Patient- level covariates (eg, demographics, blood culture results, and pleural drainage) were matched between the PICC and oral antibiotic groups. Logistic regression was used to assess the association between the antibiotic administration group and treatment failure.
Of 7,280 eligible patients, 2,123 children were included in analysis. Of these, 59% were white, and the median age was 5 years. Pleural drainage was performed in 44%, and the most common pathogen identified was Streptococcus pneumoniae. Overall, 281 (13.2%) received antibiotics via PICC at discharge.
There was no significant difference in treatment failure rates between the PICC (3.2%) and oral (2.6%) groups (odds ratio [OR], 1.26; 95% confidence interval [CI], 0.54–2.94). PICC complications occurred in 7.1% of PICC participants, the most common being PICC thrombosis resulting in malfunction (4%). The odds of an adverse drug reaction were significantly higher in the PICC group than in the oral group (OR, 19.1; 95% CI, 4.2–87.3).
The researchers conclude that children with complicated pneumonia should preferentially receive oral antibiotics at discharge when effective oral options are available.
Dr. Lesser has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Diagnosis of complicated pneumonia usually occurs when a bacterial lung infection involves the pleural space and is associated with a more severe clinical course compared to community acquired pneumonia. Children with parapneumonic effusion, empyema, necrotizing pneumonia, and/or abscess may all be assigned a diagnosis of complicated pneumonia. Most recent clinical research on this disease focuses on the role and type of pleural drainage for acute...