title: The use, appropriateness and outcomes of outpatient parenteral antimicrobial therapy.
abstract: 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.
  
  
  METHODS
  This was a 12-month prospective observational study.
  
  
  METHODS
  The hospital-in-the-home programme of The Royal Children's Hospital Melbourne.
  
  
  METHODS
  All patients receiving OPAT.
  
  
  METHODS
  Data were collected including demographics, diagnosis, type of venous access and antibiotic choice.
  
  
  METHODS
  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.
authors.affiliation: RCH@Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
authors.forename: Kate A
authors.identifier: http://orcid.org/0000-0003-3614-2388
authors.initials: KA
authors.lastname: Hodgson
authors.affiliation: RCH@Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Huynh
authors.affiliation: RCH@Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
authors.forename: Laila F
authors.initials: LF
authors.lastname: Ibrahim
authors.affiliation: RCH@Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Sacks
authors.affiliation: RCH@Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Golshevsky
authors.affiliation: RCH@Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Layley
authors.affiliation: RCH@Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Spagnolo
authors.affiliation: RCH@Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
authors.forename: Chin-Mae
authors.initials: CM
authors.lastname: Raymundo
authors.affiliation: RCH@Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia Clinical Paediatrics Group, Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia Department of Paediatrics, University of Melbourne, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
authors.forename: Penelope A
authors.initials: PA
authors.lastname: Bryant
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000188:drug therapy; D002177:Candidiasis / Q000188:drug therapy; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000706:statistics & numerical data; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000706:statistics & numerical data; D002443:Ceftriaxone / Q000008:administration & dosage; D002481:Cellulitis / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000188:drug therapy; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D007263:Infusions, Parenteral; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data; D055553:Prescription Drugs / Q000008:administration & dosage; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents; D005839:Gentamicins; D055553:Prescription Drugs; D002443:Ceftriaxone
keywords: Infectious Diseases; antibiotics; home; outpatient; parenteral