Outpatient parenteral antimicrobial therapy (OPAT) offers the option of treating children requiring intravenous antibiotics for acute urinary tract infection(UTI)/pyelonephritis at home” Scanlan et al (2018).
Abstract:
BACKGROUND: Outpatient parenteral antimicrobial therapy (OPAT) offers the option of treating children requiring intravenous antibiotics for acute urinary tract infection(UTI)/pyelonephritis at home. We aimed to determine the outcomes of treating patients with UTI/pyelonephritis using OPAT directly from the Emergency Department (ED) without admission to hospital.
METHODS: This was a retrospective study (Aug 2012-Jul 2016) of children with UTI/pyelonephritis treated with parenteral antibiotics via a peripheral cannula directly from ED to home under a hospital-in-the home (HITH) program. Data collection included demographics, clinical features, length of stay, complications and readmissions to hospital.
RESULTS: There were 62 patient episodes of UTI/pyelonephritis transferred directly from ED to HITH. 58 (94%) had systemic features including fever, vomiting, and/or tachycardia. 18 (29%) patients had an underlying condition. 9 (15%) received intravenous fluids and 8 (13%) antiemetics in ED. The OPAT course was successfully completed in 56 (90%) patients. Of 6 (10%) patients who were readmitted, 2 were discharged within 24 hours and none were severely unwell. 2 (3%) had a blocked cannula, with no antibiotic complications. HITH patients were treated for a combined total of 142 days at home resulting in a cost saving of AUD108,914 (USD82,775). However, only 8% of children deemed to require a course of IV antibiotics were transferred directly home from ED. Compared to patients concurrently admitted to hospital, fewer on HITH less than 1 year of age (13% versus 33%, OR 0.3, p<0.01).
CONCLUSIONS: Selected patients presenting to ED with UTI/pyelonephritis may be treated directly via HITH, including some with underlying conditions and/or systemic features.
Reference:
Scanlan, B.T., Ibrahim, L.F., Hopper, S.M., Babl, F.E., Davidson, A. and Bryant, P.A. (2018) Selected Children with Complicated Acute Urinary Tract Infection May be Treated with Outpatient Parenteral Antibiotic Therapy at Home Directly from the Emergency Department. The Pediatric Infectious Disease Journal. April 9th. [epub ahead of print].
doi: 10.1097/INF.0000000000002070.