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Selected Children With Complicated Acute Urinary Tract Infection May Be Treated With Outpatient Parenteral Antibiotic Therapy at Home Directly From the Emergency Department

Scanlan, Barry T., MBBCh*; Ibrahim, Laila F., MBBCh*; Hopper, Sandy M., MBBS; Babl, Franz E., MD; Davidson, Andrew, MD; Bryant, Penelope A., PhD*,§

The Pediatric Infectious Disease Journal: February 2019 - Volume 38 - Issue 2 - p e20–e25
doi: 10.1097/INF.0000000000002070
Original Studies

Background: Outpatient parenteral antimicrobial therapy offers the option of treating children requiring intravenous antibiotics for acute urinary tract infection (UTI)/pyelonephritis at home. We aimed to determine the outcomes of treating patients with UTI/pyelonephritis using outpatient parenteral antimicrobial therapy directly from the emergency department (ED) without admission to hospital.

Methods: This was a retrospective study (August 2012–July 2016) of children with UTI/pyelonephritis treated with parenteral antibiotics via a peripheral cannula directly from ED to home under a hospital-in-the home (HITH) program. Data collection included demographics, clinical features, length of stay, complications, and readmissions to hospital.

Results: There were 62 patient episodes of UTI/pyelonephritis transferred directly from ED to HITH. Fifty-eight (94%) had systemic features including fever, vomiting and/or tachycardia. Eighteen (29%) patients had an underlying condition. Nine (15%) received intravenous fluids and 8 (13%) antiemetics in ED. The outpatient parenteral antimicrobial therapy course was successfully completed in 56 (90%) patients. Of 6 (10%) patients who were readmitted, 2 were discharged within 24 hours, and none were severely unwell. Two (3%) had a blocked cannula, with no antibiotic complications. HITH patients were treated for a combined total of 142 days at home resulting in a cost saving of Australian dollar 108,914 (US dollar 82,775). However, only 8% of children deemed to require a course of intravenous antibiotics were transferred directly home from ED. Compared with patients concurrently admitted to hospital, fewer on HITH were less than 1 year of age (13% vs. 33%; odds ratio: 0.3; P < 0.01).

Conclusions: Selected patients presenting to ED with UTI/pyelonephritis may be treated directly via HITH, including some with underlying conditions and/or systemic features.

From the *Department Hospital-in-the-Home, Royal Children’s Hospital, Melbourne, Australia; Murdoch Children’s Research Institute, Melbourne, Australia

Department of Emergency Medicine, University of Melbourne, Australia.

Department of Anesthesia

§Department of Infectious Disease, Royal Children’s Hospital, Melbourne, Australia.

Accepted for publication February 15, 2018.

The study was supported by the Royal Children’s Hospital Foundation, and P.A.B. is the recipient of a Murdoch Children’s Research Institute Clinician Scientist Fellowship. The authors have no other funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Penelope A. Bryant, PhD, Department of General Medicine, The Royal Children’s Hospital Melbourne, 50 Flemington Road, Parkville, VIC 3052, Australia. E-mail: penelope.bryant@rch.org.au.

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