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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Outpatient Parenteral Antimicrobial Therapy and Judicious Use of Pediatric Emergency Resources

Michael Xu1, Quynh Doan

  • 1From the Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

Pediatric Emergency Care
|July 12, 2017
PubMed

Insights

Scheduled returns to the pediatric emergency department (PED) for outpatient parenteral antimicrobial therapy (OPAT) represent a significant burden. A notable portion of these visits for common infections could potentially be avoided with oral antibiotics.

Area of Science:

  • Pediatric Emergency Medicine
  • Antimicrobial Stewardship
  • Healthcare Utilization

Background:

  • Pediatric emergency department (PED) return visits (RTED) range from 3% to 13% of total visits.
  • The impact of scheduled RTEDs on PED utilization is not well understood.
  • Antimicrobial stewardship programs can optimize outpatient parenteral antimicrobial therapy (OPAT) use upon discharge.

Purpose of the Study:

  • Quantify the burden of scheduled RTEDs for OPAT on PED utilization.
  • Assess OPAT use against practice standards for common pediatric infections (cellulitis, pneumonia, UTIs).

Main Methods:

  • Single-center retrospective cohort study.
  • Analysis of all PED visits from May 2012 to April 2013.
  • Identification and characterization of scheduled RTEDs associated with OPAT.

Main Results:

  • 1310 (33.6%) of 3904 RTEDs were scheduled, with 1029 related to OPAT.
  • 749 OPAT-related RTEDs (69%) were for cellulitis, pneumonia, or UTIs.
  • Oral antibiotics were a viable alternative in 24% of index and 28% of subsequent OPAT-related RTEDs, suggesting OPAT could have been avoided.

Conclusions:

  • Outpatient parenteral antimicrobial therapy (OPAT) contributes significantly to pediatric emergency department utilization.
  • A substantial proportion of OPAT-related RTEDs may be preventable.
Abstract

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