A Comparison of Hospital Versus Outpatient Parenteral Antibiotic Therapy at Home for Pyelonephritis and Meningitis
A Comparison of Hospital Versus Outpatient Parenteral Antibiotic Therapy at Home for Pyelonephritis and Meningitis
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DOI：
10.1097/inf.0000000000001605
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发表时间：
2017-09-01
影响因子：
3.6
通讯作者：
Bryant, Penelope A.
中科院分区：
文献类型：
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作者：
Hensey, Conor C.;Sett, Arun;Bryant, Penelope A.
背景资料：尽管门诊肠外抗菌治疗（OPAT）的家庭治疗的好处，肾盂肾炎和脑膜炎的儿童很少包括在内。我们的目的是比较这些疾病的医院和家庭治疗的临床特征和结果，并确定影响家庭治疗的因素。方法：回顾性确定2012年1月1日至2013年12月31日期间因肾盂肾炎或确诊和推定的细菌性脑膜炎入院的儿童。接受任何OPAT的患者（家庭组）通过我们的家庭医院（HITH）计划接受每日访视;住院患者（医院组）接受标准治疗。临床和人口统计学特征，住院时间，再入院率和成本进行了比较医院和家庭groups.Results：139名儿童肾盂肾炎和70脑膜炎被确定，其中127和44是潜在的适合OPAT，分别。其中，12例（9%）肾盂肾炎接受OPAT，29例（66%）脑膜炎。两种疾病的临床特征在医院和家庭治疗的患者之间没有差异。住院组的脑膜炎患者比转入HITH组的患者更年轻（1个月对2个月; P = 0.01）。所有患者在转入HITH前均无发热。肾盂肾炎住院时间短，住院患者的住院时间短于家庭患者（中位数：3 vs. 4. 5天; P = 0. 002）。所有组的计划外再入院率相当。结论：OPAT治疗肾盂肾炎合并脑膜炎患儿是可行的。年龄、治疗时间和发烧影响这一决定。这些都不应成为OPAT的障碍，节省的费用支持实践中的变革。
Background: Despite the benefits of home treatment with outpatient parenteral antimicrobial therapy (OPAT), children with pyelonephritis and meningitis are rarely included. We aimed to compare clinical characteristics and outcomes between hospital and home treatment for these conditions and to identify factors influencing home treatment.Methods: Children admitted to the hospital with pyelonephritis or proven and presumed bacterial meningitis from January 1, 2012, to December 31, 2013 were identified retrospectively. Patients who received any OPAT (home group) received daily visits via our Hospital-in-the-Home (HITH) program; inpatients (hospital group) received standard care. Clinical and demographic features, length of stay, readmission rate and cost were compared between hospital and home groups.Results: One hundred thirty-nine children with pyelonephritis and 70 with meningitis were identified, of which 127 and 44 were potentially suitable for OPAT, respectively. Of these, 12 (9%) with pyelonephritis received OPAT, contrasting with 29 (66%) with meningitis. Clinical features did not differ between hospital-and home-treated patients for either condition. Patients with meningitis in the hospital group were younger than those transferred to HITH (1 vs. 2 months; P = 0.01). All patients were afebrile before transfer to HITH. Admissions for pyelonephritis were brief with inpatients having a shorter length of stay than home patients (median: 3 vs. 4.5 days; P = 0.002). Unplanned readmission rates were comparable across all groups. Transfer to HITH resulted in a saving of AU$178,180.Conclusions: Children with pyelonephritis and meningitis can feasibly receive OPAT. Age, treatment duration and fever influence this decision. None of these should be barriers to OPAT, and the cost savings support change in practice.