Pediatric Outpatient Parenteral Antimicrobial Therapy: An Update

Maraqa, Nizar; Rathore, Mobeen H.

doi:10.1016/j.yapd.2010.09.002

Cited by 13 publications

(14 citation statements)

References 95 publications

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“…In this study and others, catheter-related complications were generally seen in children treated for more than 2-3 weeks, 9,11,20,22 suggesting that shortening the duration of OPAT and converting to oral therapy sooner might reduce OPAT complication rates. 24 In certain infectious syndromes, it is not clear that prolonged OPAT is superior to oral therapy or early conversion to oral antibiotics after an initial short IV phase.…”

Section: Discussionsupporting

confidence: 50%

“…This is also in the range of what has previously been reported. 9,11,13,20 Despite ample literature describing OPAT-or PICCline-associated complications, 2,3,9,10,12-15,21-23 in our experience many providers initiating and managing OPAT underestimate the associated risks. There is a need to increase provider and patient education about risks associated with OPAT in children.…”

Section: Discussionmentioning

confidence: 79%

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Characteristics and Outcomes of Outpatient Parenteral Antimicrobial Therapy at an Academic Children’s Hospital

Madigan

Banerjee

2013

Pediatric Infectious Disease Journal

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Section: Discussionsupporting

confidence: 50%

Section: Discussionmentioning

confidence: 79%

Characteristics and Outcomes of Outpatient Parenteral Antimicrobial Therapy at an Academic Children’s Hospital

Madigan

Banerjee

2013

Pediatric Infectious Disease Journal

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“…OPAT is particularly desirable for children to minimise the negative psychosocial impact of hospitalisation10 and disruption to family life 7 8. Given the choice, the majority of parents prefer to be at home rather than have their child in hospital 11.…”

Section: Discussionmentioning

confidence: 99%

The use, appropriateness and outcomes of outpatient parenteral antimicrobial therapy

et al. 2016

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Objective Outpatient parenteral antimicrobial therapy (OPAT) is increasingly used to treat children at home, but studies in children are scarce. We aimed to describe the use, appropriateness and outcomes of OPAT in children. Design This was a 12-month prospective observational study. Setting The hospital-in-the-home programme of The Royal Children's Hospital Melbourne. Patients All patients receiving OPAT. Interventions Data were collected including demographics, diagnosis, type of venous access and antibiotic choice. Main outcome measures Length of stay, adverse events, readmission rate and appropriateness of antibiotic use. Results 228 patients received OPAT in 251 episodes. The median age was 7.4 years (range 1 week to 21 years), with 22 patients (10%) under 1 year. The most frequent diagnoses were exacerbation of cystic fibrosis (17%), urinary tract infection (12%) and cellulitis (9%). Most patients were transferred from the ward, but 18% were transferred directly from the emergency department, the majority with skin and soft-tissue infection (66%). Venous access was most commonly peripherally inserted central catheter (29%) and peripheral cannula (29%). 309 parenteral antibiotics were prescribed, most frequently ceftriaxone (28%) and gentamicin (19%). The majority of antibiotics (72%) were prescribed appropriately. However, 6% were deemed an inappropriate choice for the indication and 26% had inappropriate dose or duration. The incidence of central line-associated bloodstream infections was 0.9%. The unplanned readmission rate was 4%, with low rates of OPAT-related adverse events. Three children (1%) had an inadequate clinical response. Conclusions OPAT is a safe and effective way of providing antibiotics to children. Despite high rates of appropriate antibiotic use, improvements can still be made. BACKGROUND

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“…Various service models for p-OPAT are described below and their relative advantages and disadvantages are outlined in Table 3. 19 They may be used independently or in combination within a single p-OPAT service.…”

Section: Service Structurementioning

confidence: 99%

“…37 Midlines, peripherally inserted central catheters (PICC), tunnelled central venous catheters (CVC) and implanted ports have all contributed to the safe and successful delivery of antimicrobial therapy for patients under p-OPAT. 19,37 Peripheral cannulae may also be considered for short-course home therapy. Review JAC key indications and complications associated with various iv devices.…”

Section: Vascular Accessmentioning

confidence: 99%

Good practice recommendations for paediatric outpatient parenteral antibiotic therapy (p-OPAT) in the UK: a consensus statement

Patel

Abrahamson

Goldring

et al. 2014

Journal of Antimicrobial Chemotherapy

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There is compelling evidence to support the rationale for managing children on intravenous antimicrobial therapy at home whenever possible, including parent and patient satisfaction, psychological well-being, return to school/employment, reductions in healthcare-associated infection and cost savings. As a joint collaboration between the BSAC and the British Paediatric Allergy, Immunity and Infection Group, we have developed good practice recommendations to highlight good clinical practice and governance within paediatric outpatient parenteral antibiotic therapy (p-OPAT) services across the UK. These guidelines provide a practical approach for safely delivering a p-OPAT service in both secondary care and tertiary care settings, in terms of the roles and responsibilities of members of the p-OPAT team, the structure required to deliver the service, identifying patients and pathologies that are suitable for p-OPAT, ensuring appropriate vascular access, antimicrobial choice and delivery and the clinical governance aspects of delivering a p-OPAT service. The process of writing a business case to support the introduction of a p-OPAT service is also addressed.

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Pediatric Outpatient Parenteral Antimicrobial Therapy: An Update

Cited by 13 publications

References 95 publications

Characteristics and Outcomes of Outpatient Parenteral Antimicrobial Therapy at an Academic Children’s Hospital

Characteristics and Outcomes of Outpatient Parenteral Antimicrobial Therapy at an Academic Children’s Hospital

The use, appropriateness and outcomes of outpatient parenteral antimicrobial therapy

Good practice recommendations for paediatric outpatient parenteral antibiotic therapy (p-OPAT) in the UK: a consensus statement

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