一些患有复杂急性下尿路感染的儿童可能可以直接在急诊科接受门诊肠外抗生素治疗。

Selected Children With Complicated Acute Urinary Tract Infection May Be Treated With Outpatient Parenteral Antibiotic Therapy at Home Directly From the Emergency Department.

机构信息

Department of Emergency Medicine, University of Melbourne, Australia.

Department of Anesthesia.

出版信息

Pediatr Infect Dis J. 2019 Feb;38(2):e20-e25. doi: 10.1097/INF.0000000000002070.

DOI:10.1097/INF.0000000000002070

PMID:29634622

Abstract

BACKGROUND

Outpatient parenteral antimicrobial therapy 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 outpatient parenteral antimicrobial therapy directly from the emergency department (ED) without admission to hospital.

METHODS

This was a retrospective study (August 2012-July 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. Fifty-eight (94%) had systemic features including fever, vomiting and/or tachycardia. Eighteen (29%) patients had an underlying condition. Nine (15%) received intravenous fluids and 8 (13%) antiemetics in ED. The outpatient parenteral antimicrobial therapy 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. Two (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 Australian dollar 108,914 (US dollar 82,775). However, only 8% of children deemed to require a course of intravenous antibiotics were transferred directly home from ED. Compared with patients concurrently admitted to hospital, fewer on HITH were less than 1 year of age (13% vs. 33%; odds ratio: 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.

摘要

背景

门诊患者接受静脉用抗生素治疗，为急性下尿路感染（UTI）/肾盂肾炎患儿提供了在家中接受静脉抗生素治疗的选择。我们旨在确定直接从急诊科（ED）开始接受门诊患者接受静脉用抗生素治疗（UTI）/肾盂肾炎的患者的结局，而无需住院。

方法

这是一项回顾性研究（2012 年 8 月至 2016 年 7 月），纳入了通过医院到家（HITH）计划，通过外周套管直接从 ED 转至家中接受静脉用抗生素治疗的 UTI/肾盂肾炎患儿。数据收集包括人口统计学特征、临床特征、住院时间、并发症和再入院情况。

结果

共有 62 例 UTI/肾盂肾炎患者直接从 ED 转至 HITH，其中 58 例（94%）存在全身症状，包括发热、呕吐和/或心动过速。18 例（29%）患者存在基础疾病。9 例（15%）患者在 ED 中接受了静脉补液，8 例（13%）患者接受了止吐药治疗。56 例（90%）患者成功完成了门诊静脉用抗生素治疗。在 6 例（10%）再入院患者中，2 例在 24 小时内出院，无严重不适。2 例（3%）出现套管堵塞，但无抗生素相关并发症。HITH 患者在家中总共接受了 142 天的治疗，节省费用 108914 澳元（82775 美元）。然而，仅有 8%的患儿被认为需要静脉用抗生素治疗，因此从 ED 直接转回家中。与同时住院的患者相比，HITH 患者中年龄小于 1 岁的患儿较少（13%比 33%；比值比：0.3；P<0.01）。