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Drug therapy
Impact of expanding a paediatric OPAT programme with an antimicrobial stewardship intervention
  1. Julie Huynh1,2,
  2. Kate A Hodgson1,3,4,5,
  3. Suzanne Boyce1,6,7,
  4. Laila F Ibrahim1,6,8,
  5. Penelope A Bryant1,6,8,9
  1. 1 Hospital-in-the-Home Department, The Royal Children's Hospital, Parkville, Victoria, Australia
  2. 2 Discipline of Child and Adolescent Health, The University of Sydney, Westmead, New South Wales, Australia
  3. 3 Perinatal Infant and Paediatric Emergency Retrieval, The Royal Children’s Hospital, Parkville, Victoria, Australia
  4. 4 Department of Newborn Research, Royal Women’s Hospital, Parkville, Victoria, Australia
  5. 5 Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
  6. 6 Clinical Paediatrics Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
  7. 7 Department of General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia
  8. 8 Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
  9. 9 Infectious Diseases Unit, The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
  1. Correspondence to Dr Penelope A Bryant, Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia; penelope.bryant{at}rch.org.au

Abstract

Background As treatment out of hospital with outpatient parenteral antimicrobial therapy (OPAT) increases, so too does the risk for patients of being less visible, with potential for suboptimal care.

Objectives We aimed to compare pre-expansion and post-expansion (1) successful completion, complications and (2) the impact of an OPAT-specific antimicrobial stewardship (AMS) intervention to mitigate inappropriate antibiotic prescribing.

Design A prospective longitudinal study during two consecutive 12-month periods: period A (1 August 2012 to 31 July 2013) and period B (1 August 2013 to 31 July 2014).

Setting The Hospital-in-the-Home (HITH) programme at The Royal Children’s Hospital Melbourne.

Participants All patients who received OPAT during the study period.

Interventions Between the two periods, the programme expanded from 16 to 32 patients/day. To coincide with this, a combined AMS intervention was introduced: (1) OPAT-specific guidelines and (2) active review of OPAT prescriptions and input by Paediatric Infectious Diseases.

Main outcomes Successful completion of OPAT, OPAT-related complications, readmission, length of stay and antibiotic appropriateness.

Results Over 2 years, 646 patients (47% female, median age 7 years) were treated via OPAT for 754 episodes. Patient episodes increased from 254 in period A to 500 in period B, with proportional increases in infants under 1 month and immunocompromised patients. OPAT was successfully completed in 245/251 (98%) versus 473/482 (98%) (OR 1.8, 95% CI 0.7 to 4.5, p=0.3). OPAT-related complications remained low: intravenous catheter-associated complications 16/138 (12%) versus 41/414 (10%), and antibiotic-associated complications 0/254 (0%) versus 2/500 (0.4%). Despite the increase in activity, with the AMS intervention, overall appropriate antibiotic prescribing remained high: 71% versus 76%. Inappropriately long durations reduced from 30/312 (10%) to 37/617 (6%) (OR 0.6, 95% CI 0.4 to 0.99, p=0.04), and median number of days on broad-spectrum antibiotics from 11 (IQR 8–24.5) to 8 (IQR 5–11).

Conclusion During a period of substantial expansion, we maintained clinical outcomes. A modest AMS intervention reduced some but not all aspects of inappropriate antibiotic prescribing.

  • hospital at home
  • antibiotic
  • intravenous therapy

https://doi.org/10.1136/archdischild-2019-318091

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    Footnotes

    • Contributors PAB conceptualised, designed the study, co-ordinated and supervised data collection, analysed and critically reviewed the manuscript for important intellectual content. JH collected data, performed data analysis and interpretation of data, drafted and reviewed the manuscript for important intellectual content. KAH collected data, performed initial data analysis, and reviewed and revised the manuscript. SB collected data and revised the manuscript. LFI collected data and revised the manuscript. All authors approve the final manuscript to be published and agree to be accountable for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Ethics approval was granted by the Royal Children’s Hospital Human Research Ethics committee (32 291A).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request. Data are freely available on individual request.