Related Experiment Videos
A Comparison of Hospital Versus Outpatient Parenteral Antibiotic Therapy at Home for Pyelonephritis and Meningitis
Conor C Hensey1, Arun Sett, Tom G Connell
1From the *Department of General Medicine, †RCH@Home Department, ‡Clinical Paediatrics Group, Murdoch Children's Research Institute, and §Department of Paediatrics, University of Melbourne, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
Insights
Children with pyelonephritis and meningitis can safely receive outpatient parenteral antimicrobial therapy (OPAT) at home. Factors like age and fever should not prevent OPAT, which offers significant cost savings.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Health Services Research
Background:
- Outpatient parenteral antimicrobial therapy (OPAT) offers benefits but is underutilized in pediatric pyelonephritis and meningitis.
- This study investigates the feasibility and outcomes of OPAT for these specific pediatric conditions.
Purpose of the Study:
- To compare clinical characteristics and outcomes of hospital versus home-treated children with pyelonephritis and meningitis.
- To identify factors influencing the decision to provide OPAT for these pediatric infections.
Main Methods:
- Retrospective analysis of children hospitalized with pyelonephritis or bacterial meningitis (2012-2013).
- Comparison of patients receiving OPAT (home group) via a Hospital-in-the-Home (HITH) program versus standard inpatient care (hospital group).
- Evaluation of clinical features, length of stay, readmission rates, and costs.
Main Results:
- Of potentially suitable patients, 9% with pyelonephritis and 66% with meningitis received OPAT.
- No significant differences in clinical features between hospital and home-treated groups for either condition.
- Home treatment (HITH) resulted in substantial cost savings (AU$178,180) with comparable readmission rates.
Conclusions:
- Pediatric pyelonephritis and meningitis are feasible for home treatment with OPAT.
- Age, treatment duration, and fever should not be barriers to OPAT implementation.
- OPAT for these conditions is clinically viable and cost-effective, supporting practice change.
Background:
Despite the benefits of home treatment with outpatient parenteral antimicrobial therapy (OPAT), children with pyelonephritis and meningitis are rarely included. We aimed to compare clinical characteristics and outcomes between hospital and home treatment for these conditions and to identify factors influencing home treatment.
Methods:
Children admitted to the hospital with pyelonephritis or proven and presumed bacterial meningitis from January 1, 2012, to December 31, 2013 were identified retrospectively. Patients who received any OPAT (home group) received daily visits via our Hospital-in-the-Home (HITH) program; inpatients (hospital group) received standard care. Clinical and demographic features, length of stay, readmission rate and cost were compared between hospital and home groups.
Results:
One hundred thirty-nine children with pyelonephritis and 70 with meningitis were identified, of which 127 and 44 were potentially suitable for OPAT, respectively. Of these, 12 (9%) with pyelonephritis received OPAT, contrasting with 29 (66%) with meningitis. Clinical features did not differ between hospital- and home-treated patients for either condition. Patients with meningitis in the hospital group were younger than those transferred to HITH (1 vs. 2 months; P = 0.01). All patients were afebrile before transfer to HITH. Admissions for pyelonephritis were brief with inpatients having a shorter length of stay than home patients (median: 3 vs. 4.5 days; P = 0.002). Unplanned readmission rates were comparable across all groups. Transfer to HITH resulted in a saving of AU$178,180.
Conclusions:
Children with pyelonephritis and meningitis can feasibly receive OPAT. Age, treatment duration and fever influence this decision. None of these should be barriers to OPAT, and the cost savings support change in practice.