Patel Sanjay, Green Helen
Department of Paediatric Infectious Diseases & Immunology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Mailpoint 43, Tremona Road, Southampton, SO16 6YD, UK.
NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Curr Infect Dis Rep. 2019 Apr 16;21(5):17. doi: 10.1007/s11908-019-0669-6.
Over recent years, there has been a marked increase in the number of centres delivering paediatric outpatient parenteral antimicrobial therapy (pOPAT). Various factors have fuelled this drive, including the significant economic pressures faced by high-income countries to contain the cost of healthcare, resulting in a significant reduction of in-patient beds over the past 20 years. It is essential that pOPAT services have formal clinical governance structures in place to ensure the safe and effective management of children being ambulated on intravenous antibiotics. They also require oversight of antimicrobial decisions by a medically qualified infection specialist to ensure that the principles of antimicrobial stewardship are adhered to. This review aims to provide an evidence-based framework for delivering pOPAT services.
There is increasing data supporting the implementation of admission avoidance strategies for children with cellulitis and pyelonephritis. In addition, recent data supports the management of a subset of children with febrile neutropenia within pOPAT services. Above all, there is a clear recognition that embedding antimicrobial stewardship within pOPAT services reduces duration of intravenous antibiotics (IVAbs) and improves patient management. pOPAT services are safe, cost-effective and associated with high levels of parent/patient satisfaction. Further research is required to develop risk prediction models for children being considered for pOPAT. Further data about the use of elastomeric devices in children and the acceptability of parental administration of IVAbs are also required.
近年来，提供儿科门诊肠外抗菌治疗（pOPAT）的中心数量显著增加。多种因素推动了这一趋势，包括高收入国家在控制医疗成本上面临的巨大经济压力，导致过去20年住院床位大幅减少。pOPAT服务必须具备正式的临床管理结构，以确保对接受静脉抗生素治疗的儿童进行安全有效的管理。它们还需要有资质的感染专科医生对抗菌决策进行监督，以确保遵循抗菌药物管理原则。本综述旨在提供一个基于证据的pOPAT服务提供框架。
越来越多的数据支持对蜂窝织炎和肾盂肾炎患儿实施避免住院策略。此外，最近的数据支持在pOPAT服务中对一部分发热性中性粒细胞减少症患儿进行管理。最重要的是，人们清楚地认识到，将抗菌药物管理纳入pOPAT服务可缩短静脉抗生素使用时间（IVAbs）并改善患者管理。pOPAT服务安全、具有成本效益且家长/患者满意度高。需要进一步研究来开发针对考虑接受pOPAT治疗儿童的风险预测模型。还需要更多关于儿童使用弹性装置以及家长给予静脉抗生素的可接受性的数据。
