title: A Comparison of Hospital Versus Outpatient Parenteral Antibiotic Therapy at Home for Pyelonephritis and Meningitis.
abstract: 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.
authors.affiliation: From 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.
authors.forename: Conor C
authors.initials: CC
authors.lastname: Hensey
authors.forename: Arun
authors.initials: A
authors.lastname: Sett
authors.forename: Tom G
authors.initials: TG
authors.lastname: Connell
authors.forename: Penelope A
authors.initials: PA
authors.lastname: Bryant
mesh_terms: D061605:Administration, Intravenous; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D005260:Female; D006699:Home Care Services / Q000191:economics; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007223:Infant; D008297:Male; D008581:Meningitis / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D010045:Outpatients / Q000706:statistics & numerical data*; D011704:Pyelonephritis / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D012189:Retrospective Studies; D014739:Victoria / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents