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The use, appropriateness and outcomes of outpatient parenteral antimicrobial therapy
  1. Kate A Hodgson1,
  2. Julie Huynh1,
  3. Laila F Ibrahim1,
  4. Bronwyn Sacks1,
  5. Daniel Golshevsky1,
  6. Michael Layley1,
  7. Mark Spagnolo1,
  8. Chin-Mae Raymundo1,
  9. Penelope A Bryant1,2,3,4
  1. 1RCH@Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  2. 2Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  3. 3Clinical Paediatrics Group, Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  4. 4Department of Paediatrics, University of Melbourne, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  1. Correspondence to Dr Penelope A Bryant, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, VIC 3052, Australia. penelope.bryant{at}rch.org.au

Abstract

Objective Outpatient parenteral antimicrobial therapy (OPAT) is increasingly used to treat children at home, but studies in children are scarce. We aimed to describe the use, appropriateness and outcomes of OPAT in children.

Design This was a 12-month prospective observational study.

Setting The hospital-in-the-home programme of The Royal Children's Hospital Melbourne.

Patients All patients receiving OPAT.

Interventions Data were collected including demographics, diagnosis, type of venous access and antibiotic choice.

Main outcome measures Length of stay, adverse events, readmission rate and appropriateness of antibiotic use.

Results 228 patients received OPAT in 251 episodes. The median age was 7.4 years (range 1 week to 21 years), with 22 patients (10%) under 1 year. The most frequent diagnoses were exacerbation of cystic fibrosis (17%), urinary tract infection (12%) and cellulitis (9%). Most patients were transferred from the ward, but 18% were transferred directly from the emergency department, the majority with skin and soft-tissue infection (66%). Venous access was most commonly peripherally inserted central catheter (29%) and peripheral cannula (29%). 309 parenteral antibiotics were prescribed, most frequently ceftriaxone (28%) and gentamicin (19%). The majority of antibiotics (72%) were prescribed appropriately. However, 6% were deemed an inappropriate choice for the indication and 26% had inappropriate dose or duration. The incidence of central line-associated bloodstream infections was 0.9%. The unplanned readmission rate was 4%, with low rates of OPAT-related adverse events. Three children (1%) had an inadequate clinical response.

Conclusions OPAT is a safe and effective way of providing antibiotics to children. Despite high rates of appropriate antibiotic use, improvements can still be made.

  • Infectious Diseases
  • antibiotics
  • outpatient
  • home
  • parenteral

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