The use, appropriateness and outcomes of outpatient parenteral antimicrobial therapy
Kate A Hodgson1, Julie Huynh1, Laila F Ibrahim1
1RCH@Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
Insights
Outpatient parenteral antimicrobial therapy (OPAT) is safe and effective for children, with appropriate antibiotic use in most cases. While generally successful, opportunities exist to further optimize antibiotic selection and duration in pediatric OPAT programs.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Hospital-at-Home Programs
Background:
- Outpatient parenteral antimicrobial therapy (OPAT) is increasingly utilized for pediatric care at home.
- Limited studies exist on the use and outcomes of OPAT specifically in children.
Purpose of the Study:
- To describe the utilization patterns of OPAT in a pediatric population.
- To assess the appropriateness of antibiotic prescribing and clinical outcomes associated with pediatric OPAT.
Main Methods:
- A 12-month prospective observational study was conducted.
- Data collected included patient demographics, diagnoses, venous access type, and antibiotic choices.
- Outcomes assessed were length of stay, adverse events, readmission rates, and antibiotic appropriateness.
Main Results:
- 228 children received OPAT over 251 episodes, with common diagnoses including cystic fibrosis exacerbations, urinary tract infections, and cellulitis.
- 72% of prescribed parenteral antibiotics were appropriate; however, 6% were inappropriate choices and 26% had inappropriate dosing or duration.
- Low rates of adverse events (0.9% central line-associated bloodstream infections, 4% readmission) were observed.
Conclusions:
- OPAT is a safe and effective modality for delivering antimicrobial therapy to children in an outpatient setting.
- While antibiotic use is largely appropriate, there is potential for improvement in antibiotic selection, dose, and duration.
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.
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