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Published on: August 30, 2018
Outpatient parenteral antimicrobial therapy: how young is too young?
Kate Alison Hodgson1,2, Ruth Lim2, Julie Huynh3
1Hospital in the Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia Kate.Hodgson@thewomens.org.au.
Insights
Outpatient parenteral antimicrobial therapy (OPAT) is safe and effective for neonates and older infants. This study found high success rates and low readmissions for both age groups receiving OPAT.
Area of Science:
- Pediatric Infectious Diseases
- Neonatal Care
- Antimicrobial Stewardship
Background:
- Outpatient parenteral antimicrobial therapy (OPAT) is increasingly utilized for pediatric patients.
- Limited data exists on OPAT efficacy and safety specifically in neonates compared to older infants.
Purpose of the Study:
- To evaluate the use, efficacy, and outcomes of OPAT in neonates (≤28 days) versus older infants (1-12 months).
- To compare complication rates and readmission rates between these two pediatric age groups receiving OPAT.
Main Methods:
- Prospective 8-year observational study (2012-2020) at a Hospital-in-the-Home program.
- Comparison of 76 neonatal OPAT episodes with 405 older infant OPAT episodes.
- Data collected on demographics, diagnoses, venous access, antibiotic choice, success, appropriateness, complications, and readmissions.
Main Results:
- Meningitis was the most common diagnosis in both neonates (59%) and infants (35%).
- Vascular access complication rates were 19% in neonates vs. 13% in infants (p=0.2); no central line-associated bloodstream infections occurred.
- Successful OPAT completion was high (100% neonates, 96% infants), with low readmission rates (5% neonates, 7% infants).
Conclusions:
- OPAT is a safe and effective treatment for selected, clinically stable neonatal patients.
- Appropriate antibiotic prescribing was high in both groups, indicating good antimicrobial stewardship.
- While effective, opportunities for further optimization of antibiotic use in OPAT for neonates exist.
Objective:
To report the use, and assess the efficacy and outcomes of outpatient parenteral antimicrobial therapy (OPAT) in neonates (≤28 days of age), compared with older infants (1-12 months of age).
Design:
A prospective 8-year observational study from September 2012 to September 2020.
Setting:
The Hospital-in-the-Home (HITH) programme of the Royal Children's Hospital Melbourne.
Patients:
Neonatal patients (≤28 days of age) were compared with older infants (1-12 months of age) receiving OPAT.
Interventions:
Data were collected including demographics, diagnosis, type of venous access and antibiotic choice.
Main Outcome Measures:
Success of OPAT, antibiotic appropriateness, complications and readmission rate.
Results:
There were 76 episodes for which neonates were admitted to HITH for OPAT, and 405 episodes for older infants. Meningitis was the most common diagnosis in both groups (59% and 35%, respectively); the most frequently prescribed antibiotic was ceftriaxone for both groups (61% and 49%). A positive bacterial culture was less frequent in neonates (38% vs 53%, p=0.02). Vascular access complication rate was 19% in neonates compared with 13% in older infants (p=0.2) with no central line-associated bloodstream infection in either group. Rates of appropriate antibiotic prescribing were similarly high between groups (93% vs 90%, p=0.3). The OPAT course was successfully completed in 74 of 74 (100%) neonates and 380 of 396 (96%) older infants (p=0.09). The unplanned readmission rate was low: 4 of 76 (5%) neonates and 27 of 405 (7%) older infants.
Conclusions:
OPAT is a safe and effective way of providing antibiotics to selected clinically stable neonatal patients. While appropriate antibiotic use was common, improvements can still be made.
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