Department of RCH@Home, The Royal Children's Hospital, Parkville, Victoria, Australia.
Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
Emerg Med J. 2017 Dec;34(12):780-785. doi: 10.1136/emermed-2017-206829. Epub 2017 Oct 4.
Children with moderate/severe cellulitis requiring intravenous antibiotics are usually admitted to hospital. Admission avoidance is attractive but there are few data in children. We implemented a new pathway for children to be treated with intravenous antibiotics at home and aimed to describe the characteristics of patients treated on this pathway and in hospital and to evaluate the outcomes.
This is a prospective, observational cohort study of children aged 6 months-18 years attending the ED with uncomplicated moderate/severe cellulitis in March 2014-January 2015. Patients received either intravenous ceftriaxone at home or intravenous flucloxacillin in hospital based on physician discretion. Primary outcome was treatment failure defined as antibiotic change within 48 hours due to inadequate clinical improvement or serious adverse events. Secondary outcomes include duration of intravenous antibiotics and complications.
115 children were included: 47 (41%) in the home group and 68 (59%) in the hospital group (59 hospital-only, 9 transferred home during treatment). The groups had similar clinical features. 2/47 (4%) of the children in the home group compared with 8/59 (14%) in the hospital group had treatment failure (P=0.10). Duration of intravenous antibiotics (median 1.9 vs 1.8 days, P=0.31) and complications (6% vs 10%, P=0.49) were no different between groups. Home treatment costs less, averaging $A1166 (£705) per episode compared with $A2594 (£1570) in hospital.
Children with uncomplicated cellulitis may be able to avoid hospital admission via a home intravenous pathway. This approach has the potential to provide cost and other benefits of home treatment.
需要静脉使用抗生素治疗的中重度蜂窝织炎患儿通常需要住院治疗。避免住院很有吸引力，但儿童相关数据较少。我们为儿童实施了一种新的治疗途径，即在家庭中接受静脉抗生素治疗，并旨在描述通过该途径和住院治疗的患者的特征，并评估治疗结局。
这是一项 2014 年 3 月至 2015 年 1 月期间对急诊科就诊的 6 月龄至 18 岁患有单纯性中重度蜂窝织炎的儿童进行的前瞻性观察性队列研究。根据医生的判断，患者在家中接受静脉头孢曲松或在医院接受静脉氟氯西林治疗。主要结局是治疗失败，定义为因临床改善不足或严重不良事件而在 48 小时内改变抗生素。次要结局包括静脉使用抗生素的时间和并发症。
共纳入 115 例儿童：47 例（41%）在家庭组，68 例（59%）在医院组（59 例仅住院，9 例在治疗过程中转为家庭治疗）。两组的临床特征相似。家庭组有 2/47（4%）例患儿和医院组有 8/59（14%）例患儿治疗失败（P=0.10）。静脉使用抗生素的时间（中位数 1.9 天 vs 1.8 天，P=0.31）和并发症（6% vs 10%，P=0.49）在两组之间无差异。家庭治疗费用较低，平均每次治疗费用为 1166 澳元（705 英镑），而医院治疗费用为 2594 澳元（1570 英镑）。
患有单纯性蜂窝织炎的儿童可能能够通过家庭静脉途径避免住院治疗。这种方法有可能提供家庭治疗的成本和其他益处。
