title: Outpatient Parenteral Antimicrobial Therapy in Pediatric Medicaid Enrollees.
abstract: BACKGROUND
  Outpatient parenteral antimicrobial therapy (OPAT) is overused in cases where highly bioavailable oral alternatives would be equally effective. However, the scope of OPAT use for children nationwide is poorly understood. Our objective was to characterize OPAT use and clinical outcomes for a large population of pediatric Medicaid enrollees treated with OPAT.
  
  
  METHODS
  We analyzed the Truven MarketScan Medicaid claims database between 2009 and 2012. An OPAT episode was identified by capturing children with claims data indicating home infusion therapy for an intravenous antimicrobial. We characterized OPAT use by describing patient demographics, diagnoses, and antimicrobials prescribed. We categorized an antimicrobial as highly bioavailable if ≥80% systemic exposure was expected from the peroral dose. We also determined the percentage of OPAT recipients in whom a follow-up healthcare encounter occurred during the OPAT episode in either the emergency department or as a hospital admission. We reviewed the primary diagnoses associated with these healthcare encounters to determine whether it was related to OPAT.
  
  
  RESULTS
  We identified 3433 OPAT episodes in 2687 patients. A total of 4774 antimicrobials were prescribed during these episodes. Ceftriaxone and vancomycin were the most commonly prescribed antimicrobials. Highly bioavailable antimicrobials accounted for 34% of antimicrobials used for OPAT. An emergency department visit or hospital admission occurred during 38% of OPAT episodes, among which 61% were OPAT-related.
  
  
  CONCLUSIONS
  The high rate of medical encounters associated with OPAT in this cohort and the common prescribing of highly bioavailable antimicrobials underscore the opportunities for antimicrobial stewardship of pediatric OPAT.
authors.affiliation: Children's Mercy Hospitals and Clinics, Kansas City, Missouri.|University of Missouri-Kansas City.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Goldman
authors.affiliation: Children's Hospital Association, Overland Park, Kansas.
authors.forename: Troy
authors.initials: T
authors.lastname: Richardson
authors.affiliation: Children's Mercy Hospitals and Clinics, Kansas City, Missouri.|University of Missouri-Kansas City.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newland
authors.affiliation: Children's Mercy Hospitals and Clinics, Kansas City, Missouri.|University of Missouri-Kansas City.
authors.forename: Brian
authors.initials: B
authors.lastname: Lee
authors.affiliation: Children's Hospital of Philadelphia, Pennsylvania.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Gerber
authors.affiliation: Children's Hospital Association, Overland Park, Kansas.
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.affiliation: Seattle Children's, Washington.
authors.forename: Matthew
authors.initials: M
authors.lastname: Kronman
authors.affiliation: University of Utah School of Medicine, Salt Lake City.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Hersh
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000097:blood / Q000627:therapeutic use*; D001682:Biological Availability; D002648:Child; D002675:Child, Preschool; D005260:Female; D018718:Home Infusion Therapy; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D007345:Insurance Claim Review; D008297:Male; D008484:Medicaid; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents
keywords: outpatient parenteral antimicrobial therapy; pediatrics