Hodgson Kate Alison, Lim Ruth, Huynh Julie, Nind Ben, Katz Naomi, Marlow Robin, Hensey Conor C, Scanlan Barry, Ibrahim Laila F, Bryant Penelope A
Hospital in the Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia.
Arch Dis Child. 2022 Sep 20;107(10):884-889. doi: 10.1136/archdischild-2022-324143.
To report the use, and assess the efficacy and outcomes of outpatient parenteral antimicrobial therapy (OPAT) in neonates (≤28 days of age), compared with older infants (1-12 months of age).
A prospective 8-year observational study from September 2012 to September 2020.
The Hospital-in-the-Home (HITH) programme of the Royal Children's Hospital Melbourne.
Neonatal patients (≤28 days of age) were compared with older infants (1-12 months of age) receiving OPAT.
Data were collected including demographics, diagnosis, type of venous access and antibiotic choice.
Success of OPAT, antibiotic appropriateness, complications and readmission rate.
There were 76 episodes for which neonates were admitted to HITH for OPAT, and 405 episodes for older infants. Meningitis was the most common diagnosis in both groups (59% and 35%, respectively); the most frequently prescribed antibiotic was ceftriaxone for both groups (61% and 49%). A positive bacterial culture was less frequent in neonates (38% vs 53%, p=0.02). Vascular access complication rate was 19% in neonates compared with 13% in older infants (p=0.2) with no central line-associated bloodstream infection in either group. Rates of appropriate antibiotic prescribing were similarly high between groups (93% vs 90%, p=0.3). The OPAT course was successfully completed in 74 of 74 (100%) neonates and 380 of 396 (96%) older infants (p=0.09). The unplanned readmission rate was low: 4 of 76 (5%) neonates and 27 of 405 (7%) older infants.
OPAT is a safe and effective way of providing antibiotics to selected clinically stable neonatal patients. While appropriate antibiotic use was common, improvements can still be made.
报告新生儿（≤28日龄）与较大婴儿（1 - 12月龄）门诊静脉抗菌药物治疗（OPAT）的使用情况，并评估其疗效及治疗结果。
2012年9月至2020年9月为期8年的前瞻性观察性研究。
墨尔本皇家儿童医院的家庭医院（HITH）项目。
将接受OPAT的新生儿患者（≤28日龄）与较大婴儿（1 - 12月龄）进行比较。
收集的数据包括人口统计学资料、诊断、静脉通路类型及抗生素选择。
OPAT的成功率、抗生素使用合理性、并发症及再入院率。
新生儿因OPAT入住HITH有76例次，较大婴儿有405例次。两组中最常见的诊断均为脑膜炎（分别为59%和35%）；两组最常使用的抗生素均为头孢曲松（分别为61%和49%）。新生儿细菌培养阳性率较低（38%对53%，p = 0.02）。新生儿血管通路并发症发生率为19%，较大婴儿为13%（p = 0.2），两组均无中心静脉导管相关血流感染。两组抗生素合理使用率相似（93%对90%，p = 0.3）。74例新生儿中的74例（100%）及396例较大婴儿中的380例（96%）成功完成了OPAT疗程（p = 0.09）。计划外再入院率较低：76例新生儿中有4例（5%），405例较大婴儿中有27例（7%）。
OPAT是为部分临床稳定的新生儿患者提供抗生素的一种安全有效的方式。虽然抗生素使用合理情况较为普遍，但仍有改进空间。
