Tanner E, Munro A P S, Gray J, Green H, Rutter M, Jones C E, Faust S N, Alderton M, Patel S V
University of Southampton Medical School, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Department of Paediatric Immunology & Infectious Diseases, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
JAC Antimicrob Resist. 2020 Mar 13;2(1):dlaa011. doi: 10.1093/jacamr/dlaa011. eCollection 2020 Mar.
Antimicrobial resistance (AMR) is being recognized as a priority by healthcare organizations across the world. However, many children are managed on IV antimicrobials in hospital with very little consideration of antimicrobial stewardship issues.
A nurse-led paediatric ambulatory outpatient parenteral antimicrobial therapy (OPAT) service, managing children with common infections being ambulated on short courses of IV antimicrobials, was introduced within Southampton Children's Hospital in January 2018. We evaluated the impact of this service in terms of the quality of antimicrobial prescribing and timing of ambulation in children presenting with common infections.
All cases managed within the service were reviewed in two separate 2 month time periods: prior to introduction of the service (September-October 2016) and then prospectively after its introduction (September-October 2018).
A total of 96% of IV antibiotic management decisions at 48 h were deemed appropriate in 2018, compared with 75% in 2016. A total of 64% of patients were ambulated on IV antibiotics at some point during their treatment course in 2018, compared with 19% in 2016. However, a significant proportion of antimicrobial decisions made at the point of presentation to hospital remained suboptimal in 2018.
Children are commonly managed with IV antibiotics in hospital. We demonstrate marked improvements in appropriate antimicrobial use through the introduction of a nurse-led ambulatory OPAT service. In addition, such a service can promote a greater proportion of children being ambulated from hospital, freeing up valuable inpatient beds and potentially delivering cost savings that can be used to fund such services.
抗菌药物耐药性（AMR）已被全球医疗机构视为首要问题。然而，许多儿童在医院接受静脉抗菌药物治疗时，很少考虑抗菌药物管理问题。
2018年1月，南安普敦儿童医院引入了一项由护士主导的儿科门诊胃肠外抗菌药物治疗（OPAT）服务，用于管理接受短期静脉抗菌药物治疗的常见感染儿童。我们从抗菌药物处方质量和常见感染儿童出院时间方面评估了该服务的影响。
对该服务管理的所有病例在两个独立的2个月时间段内进行回顾：服务引入前（2016年9月至10月）和引入后前瞻性观察（2018年9月至10月）。
2018年，48小时时96%的静脉抗生素管理决策被认为是恰当的，而2016年为75%。2018年，64%的患者在治疗过程中的某个时间点接受了静脉抗生素治疗后出院，而2016年为19%。然而，2018年在患儿入院时做出的很大一部分抗菌药物决策仍不尽人意。
儿童在医院通常接受静脉抗生素治疗。我们通过引入由护士主导的门诊OPAT服务，证明了在合理使用抗菌药物方面有显著改善。此外，这样的服务可以促使更多儿童出院，腾出宝贵的住院床位，并有可能节省成本，用于资助此类服务。
