Stockmann Chris, Ampofo Krow, Pavia Andrew T, Byington Carrie L, Sheng Xiaoming, Greene Tom H, Korgenski Ernest K, Hersh Adam L
Departments of Pediatrics and.
Departments of Pediatrics and Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah; and.
Hosp Pediatr. 2015 Dec;5(12):605-12. doi: 10.1542/hpeds.2015-0100. Epub 2015 Jan 1.
Treatment of pediatric parapneumonic empyema (PPE) requires several weeks of antibiotic therapy that is typically completed in the outpatient setting. The route of outpatient therapy can be oral or intravenous (outpatient parenteral antibiotic therapy [OPAT]). No studies have compared outcomes between oral therapy and OPAT for PPE.
We identified children <18 years hospitalized from 2005 to 2014 at Primary Children's Hospital with PPE and discharged with oral therapy or OPAT. The primary outcome was the percentage of children who experienced all-cause complications after discharge. Complications included those that were related to pneumonia (including treatment failure, defined as readmission with reaccumulation of pleural fluid or abscess requiring drainage) or antibiotic therapy (eg, allergy, line clot) resulting in either a hospital readmission or emergency department/urgent care visit. All-cause complications were compared between oral therapy and OPAT by using propensity score-weighted logistic regression.
A total of 391 children were hospitalized with PPE; 337 (86%) were discharged with OPAT; 35 (9%) children experienced an all-cause complication, including 5 with oral (9.3%) and 30 (8.9%) with OPAT. Pneumonia and treatment-related complications were comparable (P = .25 and .78, respectively). Two patients treated with OPAT (1%) experienced treatment failure. After adjustment using propensity score weighting, the frequency of complications was similar between groups (adjusted odds ratio 0.97, 95% confidence interval 0.23-4.65).
The frequency of complications was similar with oral therapy and OPAT for children with PPE. Oral antibiotics may be considered safe and effective for children with PPE who will be discharged to complete therapy in the outpatient setting.
小儿肺炎旁胸腔积液（PPE）的治疗需要数周的抗生素治疗，通常在门诊完成。门诊治疗途径可以是口服或静脉注射（门诊胃肠外抗生素治疗[OPAT]）。尚无研究比较PPE口服治疗和OPAT的疗效。
我们确定了2005年至2014年在 Primary Children's Hospital 住院治疗PPE并出院后接受口服治疗或OPAT的18岁以下儿童。主要结局是出院后发生全因并发症的儿童百分比。并发症包括与肺炎相关的并发症（包括治疗失败，定义为因胸腔积液再次积聚或需要引流的脓肿再次入院）或导致再次入院或急诊/紧急护理就诊的抗生素治疗相关并发症（如过敏、管路堵塞）。通过倾向评分加权逻辑回归比较口服治疗和OPAT的全因并发症。
共有391名儿童因PPE住院；337名（86%）出院时接受OPAT；35名（9%）儿童发生全因并发症，其中口服治疗组5名（9.3%），OPAT组30名（8.9%）。肺炎和治疗相关并发症相当（分别为P = 0.25和0.78）。两名接受OPAT治疗的患者（1%）出现治疗失败。使用倾向评分加权调整后，两组并发症发生率相似（调整后的优势比为0.97，95%置信区间为0.23 - 4.65）。
PPE儿童口服治疗和OPAT的并发症发生率相似。对于将出院在门诊完成治疗的PPE儿童，口服抗生素可能被认为是安全有效的。
