1540. Once Daily Ceftriaxone for Children with Moderate/Severe Cellulitis at Home
Session: Poster Abstract Session: Clinical Infectious Diseases: Soft Tissue Infections (ABSSSIs)
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • 150197 BRYANT poster 2015_CHOICE.pdf (2.4 MB)
  • Background:

    Adults with cellulitis commonly have intravenous antibiotics administered as outpatients, whereas most children are admitted to hospital. We implemented direct admission from the Emergency Department (ED) to our hospital-in-the-home (HITH) programme for children with moderate/severe cellulitis for intravenous treatment with ceftriaxone at home. We compared clinical features, microbiology and outcomes between those who received ceftriaxone (home) and those who received standard care in hospital (flucloxacillin).

    Methods:

    This is a prospective study comparing inpatient versus home care of cellulitis requiring intravenous antibiotics. All patients aged 6 months to 18 years attending ED with cellulitis from April 2014 to Dec 2015 were eligible. All patients in the study had blood cultures, swabs and prospective data collection of clinical features and outcomes.

    Results:

    Here we present the interim results, with final results to be presented at the conference. To date (over 7 months), 69 patients are included in the outcome analysis, 36 (52%) were admitted to HITH and 33 (48%) as hospital inpatients. Patients had similar demographics and cellulitis characteristics (table 1). Nasal swabs were only positive for isolates in those with a positive wound swab. All S.aureusisolates were sensitive to ceftriaxone. Other outcomes were not different between the two groups.

    Conclusion:

    Children with uncomplicated cellulitis may be successfully treated at home. Children with uncomplicated cellulitis are unlikely to have bacteraemia. Nasal swabs are not useful in the initial management of cellulitis.

     

    HITH (%)

    Ward (%)

     p value

    Demographics

    Total patients, n (%)

    36 (52)

    33 (48)

    0.6

    Female, n (%)

    17 (47)

     13 (39)

    0.5

    Age (y):mean (range)

    6.2 (1-16)

    5.8 (0.8-17)

    0.4

    Clinical features

    Prior oral antibiotic

    18 (50)

    14 (42)

    0.4

    Systemic symptoms

    15 (42)

    13 (39)

    0.4

    Microbiology features

    Skin swab

         Total

         MSSA

         MRSA

         GAS

    17 (47)

    6 (46)

    3 (23)

    3 (15)

    12 (36)

    6 (38)

    3 (19)

    1

    0.1

    0.3

    0.7

    0.7

    Nasal swab

         Total

         MSSA

         MRSA

    24 (67)

    1 (3)

    2 (8)

    22 (67)

    1 (3)

    0

    0.4

    0.5

    0.3

    Blood culture

         Total

         No growth

    30 (83)

    30 (100)

    26 (80)

    26 (100)

    0.9

    0.9

    Ceftriaxone susceptibility

         MSSA

    6 (100)

    6 (100)

    0.9

    Laila Ibrahim, MBBChBAO1,2,3, Sandy Hopper, MBBS3,4, Suzanne Boyce, MBBS1, Franz Babl, MD2,3,4, Andrew Daley, MBBS5,6 and Penelope Bryant, PhD1,3,6, (1)Rch@Home, Royal Children's Hospital, Parkville, Australia, (2)Department of Paediatrics, University of Melbourne, Parkville, Australia, (3)Murdoch Childrens Research Institute, Parkville, Australia, (4)Emergency Department, The Royal Children's Hospital, Parkville, Australia, (5)Microbiology Department, The Royal Children's Hospital, Parkville, Australia, (6)Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital, Parkville, Australia

    Disclosures:

    L. Ibrahim, None

    S. Hopper, None

    S. Boyce, None

    F. Babl, None

    A. Daley, 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.