1480. The use, outcomes and appropriateness of outpatient parenteral antimicrobial therapy in children
Session: Poster Abstract Session: Antimicrobial Stewardship: Pediatric and OPAT
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • 150186 BRYANT poster 2015_OPAT.pdf (2.6 MB)
  • Background:

    Outpatient parenteral antimicrobial therapy (OPAT) delivered via our hospital-in-the-home (HITH) service has grown rapidly. We aimed to assess our OPAT usage and evaluate quality outcomes and antibiotic appropriateness.

    Methods:

    Data regarding OPAT were prospectively collected over two consecutive periods: period A (Aug 2012-July 2013) and period B (Aug 2013-July 2014). In period B increased medical oversight was introduced, which included a paediatric infectious diseases consultant, a hospital-in-the-home registrar, and the introduction of antibiotic guidelines specifically for patients on HITH.

     

    Results:

    Demographics

    In period A, there were 1899 patients admitted to HITH of which 246 (13%) received OPAT. In period B there were 2675 patients of which 546 (20%) received OPAT.

    Clinical features

    Cystic fibrosis exacerbation was the most common diagnosis (32%). The most commonly isolated microorganisms were Enterobacteriacae (24%) and methicillin sensitive Staphylococcus aureus (8%).

    Antibiotic prescribing

    The most commonly prescribed antibiotics were ceftriaxone and gentamicin. The broad spectrum antibiotics ceftriaxone (p=0.01), ticarcillin/clavulanate (p=0.02) and piperacillin/tazobactam (p=0.03) were used more frequently in period B. Appropriateness of antibiotic prescribing improved from 67% to 75% (p=0.03) (Table 1). The greatest improvement was seen in reducing excessive duration from 7% to 2% (p<0.001).

    Outcomes

    The unplanned admission rate was similar between both periods (10% vs 7%). CLABSI rates were very low at <1%. There were no serious adverse events during either period of data collection.

    Conclusion:

    Our OPAT quality outcomes remained good and appropriate antibiotic prescribing has improved significantly. 

    Table 1  Inappropriate antibiotic prescribing

     

    Period A

    (N=301)

     Period B

    (N=632)

         p  

      value                   

    Type of prescribing no. (%)

         Appropriate decision

         Appropriate decision, incorrect  

         application

         Inappropriate decision

         Inappropriate choice

         Inappropriate application

    Inappropriate prescribing no. (%)

         Correct application

         Incorrect dosages

         Incorrect duration

         Incorrect dosing interval

         Incorrect route

              

    .

    207 (67)

    72 (24)

    .

    0 (0)

    15 (6)

    7 (3)

    .

    213 (70)

    63 (21)

    24 (8)

    1 (0.3)

    3 (1)

    .

    478 (75)

    109 (17)

    .

    2 (0.3)

    38 (6)

    5 (0.8)

    .

    501 (79)

    118 (19)

    15 (2)

    1 (0.2)

    0 (0)

    .

      0.027

     0.020

    .

    0.562

    0.631

    0.064

    .

    0.003

    0.467

    <0.001

    0.996

     0.033

    Julie Huynh, MBBS1, Kate Hodgson, MBBS1, Suzanne Boyce, MBBS1, Laila Ibrahim, MBBChBAO1,2,3 and Penelope Bryant, PhD1,4,5, (1)Rch@Home, Royal Children's Hospital, Parkville, Australia, (2)Murdoch Children's Research Institute, Parkville, Australia, (3)University of Melbourne, Department of Paediatrics, Parkville, Australia, (4)Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital, Parkville, Australia, (5)Murdoch Childrens Research Institute, Parkville, Australia

    Disclosures:

    J. Huynh, None

    K. Hodgson, None

    S. Boyce, None

    L. Ibrahim, None

    P. Bryant, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.