Hodgson Kate A, Huynh Julie, Ibrahim Laila F, Sacks Bronwyn, Golshevsky Daniel, Layley Michael, Spagnolo Mark, Raymundo Chin-Mae, Bryant Penelope A
RCH@Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
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.
Arch Dis Child. 2016 Oct;101(10):886-93. doi: 10.1136/archdischild-2015-309731. Epub 2016 May 10.
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.
This was a 12-month prospective observational study.
The hospital-in-the-home programme of The Royal Children's Hospital Melbourne.
All patients receiving OPAT.
Data were collected including demographics, diagnosis, type of venous access and antibiotic choice.
Length of stay, adverse events, readmission rate and appropriateness of antibiotic use.
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.
OPAT is a safe and effective way of providing antibiotics to children. Despite high rates of appropriate antibiotic use, improvements can still be made.
门诊胃肠外抗菌治疗（OPAT）越来越多地用于在家中治疗儿童，但针对儿童的研究较少。我们旨在描述儿童OPAT的使用情况、合理性及治疗结果。
这是一项为期12个月的前瞻性观察研究。
墨尔本皇家儿童医院的家庭医院项目。
所有接受OPAT治疗的患者。
收集的数据包括人口统计学信息、诊断结果、静脉通路类型及抗生素选择。
住院时间、不良事件、再入院率及抗生素使用的合理性。
228例患者接受了251次OPAT治疗。中位年龄为7.4岁（范围为1周龄至21岁），其中22例（10%）年龄小于1岁。最常见的诊断为囊性纤维化急性加重（17%）、尿路感染（12%）和蜂窝织炎（9%）。大多数患者由病房转入，但18%是直接从急诊科转入，其中大多数患有皮肤和软组织感染（66%）。静脉通路最常用的是外周中心静脉导管（29%）和外周静脉套管针（29%）。共开具了309种胃肠外抗生素，最常用的是头孢曲松（28%）和庆大霉素（19%）。大多数抗生素（72%）的使用是合理的。然而，6%被认为对适应证选择不当，26%的剂量或疗程不合适。中心静脉导管相关血流感染的发生率为0.9%。计划外再入院率为4%，OPAT相关不良事件发生率较低。3名儿童（1%）临床反应欠佳。
OPAT是为儿童提供抗生素治疗的一种安全有效的方式。尽管抗生素合理使用率较高，但仍有改进空间。
