scholarly journals Trends in Use of Postdischarge Intravenous Antibiotic Therapy for Children

2020 ◽  
Vol 15 (12) ◽  
pp. 731-733
Author(s):  
Michael E Fenster ◽  
AdamL Hersh ◽  
Rajendu Srivastava ◽  
Ron Keren ◽  
Jacob Wilkes ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Oral Therapy ◽  
Complicated Appendicitis ◽  
Substantial Variation ◽  
Intravenous Antibiotic ◽  
Peripherally Inserted Central Catheters ◽  
Hospital Database ◽  
Intravenous Antibiotics ◽  
Central Catheters ◽  
Complicated Pneumonia

Children with complicated appendicitis, osteomyelitis, and complicated pneumonia have historically been treated with postdischarge intravenous antibiotics (PD-IV) using peripherally inserted central catheters (PICCs). Recent studies have shown no advantage and increased complications of PD-IV, compared with oral therapy, and the extent to which use of PD-IV has since changed for these conditions is not known. We used a national children’s hospital database to evaluate trends in PD-IV during 2000-2018 for each of these three conditions. PD-IV decreased from 13% to 2% (risk ratio [RR], 0.15; 95% CI, 0.14-0.16) for complicated appendicitis, 61% to 22% (RR, 0.41; 95% CI, 0.39-0.43) for osteomyelitis, and 29% to 19% (RR, 0.63; 95% CI, 0.58-0.69) for complicated pneumonia. Despite these overall reductions, substantial variation in PD-IV use by hospital remains in 2018.

scholarly journals Outpatient Intravenous Antibiotic Therapy: The Vancouver Hospital experience

2000 ◽  
Vol 11 (suppl a) ◽  
pp. 11A-14A ◽  
Author(s):  
Grant Stiver ◽  
Amy Wai ◽  
Lynne Chase ◽  
Luciana Frighetto ◽  
Carlo Marra ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Home Environment ◽  
Average Duration ◽  
Intravenous Therapy ◽  
Intravenous Antibiotic ◽  
Intravenous Antibiotic Therapy ◽  
Days Of Therapy ◽  
Vancouver Hospital ◽  
Infectious Disease Service ◽  
Central Catheters

From June 1, 1995 to December 31, 1997, 334 patients at the Vancouver Hospital and Health Sciences Centre (VHHSC) were referred to and screened for, outpatient intravenous antibiotic therapy. One hundred and ninety were accepted, 107 of whom were cared for under the VHHSC program and 83 of whom were discharged to continue intravenous therapy in their own health region. Thirty-four of 144 patients not accepted for outpatient intravenous therapy, were screened by the Infectious Disease Service and Pharmacy, and were discharged on oral antibiotics. Peripherally inserted central catheters were employed in 61 of 107 (57%) patients, peripheral short catheters in 20 (19%), Hickman lines in 14 (13%), and Port-a-caths in 12 (12%). Ninety-two of 107 patients treated in the VHHSC program completed their course uneventfully with resolution of the infection. The average duration of hospital therapy was 10.9 days versus 23.6 days of outpatient therapy. In 15 patients, home treatment was discontinued because of clinical deterioration: adverse drug reaction (n=2), phlebitis (n=2), unsuitable home environment (n=1), noncompliance (n=1), line-related sepsis (n=1) and death due to unrelated causes (n=1). There were 15 adverse drug reactions overall in the total of 2534 patient-days of therapy over 18 months. Cost analysis showed a cost of 12 cents on the dollar compared with inhospital therapy.

scholarly journals An Algorithm for the Management of Acute Bacterial Cellulitis

2000 ◽  
Vol 11 (suppl d) ◽  
pp. 11D-14D
Author(s):  
H Grant Stiver ◽  
The Cellulitis Care Plan Working Group
Keyword(s):  
Staphylococcus Aureus ◽  
Antibiotic Therapy ◽  
Patient Compliance ◽  
Oral Therapy ◽  
Family Physicians ◽  
Skin Inflammation ◽  
Bite Wound ◽  
Intravenous Antibiotics ◽  
Step Down ◽  
Common Infection

Acute bacterial cellulitis is a common infection seen by family physicians; it is usually caused by beta-hemolytic streptococci and/or Staphylococcus aureus. Cellulitis following bite wound injuries from animals and humans requires antibiotics directed at the mouth microflora characteristic of the biting animal. Depending on the severity and the rapidity of the progression of the infection, as well as patient compliance with oral therapy, intravenous antibiotics may be required for treatment, and this may often be accomplished with an outpatient administration program. In addition to intravenous and subsequent oral step-down antibiotic therapy, special attention needs to be applied to reducing or eliminating predisposing factors such as pre-existent edema and local fungi, or other forms of dermatitis. With effective antibiotic therapy, the erythema generated by acute cellulitis may resolve quickly or slowly, but usually does so progressively. Patients with persistent skin inflammation and swelling must be examined carefully for subcutaneous abscess formation.

Clinical and Economic Consequences of Failure of Initial Antibiotic Therapy for Hospitalized Patients With Complicated Skin and Skin-Structure Infections

2008 ◽  
Vol 29 (2) ◽  
pp. 160-169 ◽  
Author(s):  
John Edelsberg ◽  
Ariel Berger ◽  
David J. Weber ◽  
Rajiv Mallick ◽  
Andreas Kuznik ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Treatment Failure ◽  
Intravenous Antibiotic ◽  
Skin Structure ◽  
Intravenous Antibiotic Therapy ◽  
Initial Antibiotic Therapy ◽  
Intravenous Antibiotics ◽  
Complicated Skin ◽  
Hospital Days ◽  
The Impact

Objective.To estimate the consequences of failure of initial antibiotic therapy for patients with complicated skin and skin-structure infections.Design.Retrospective cohort study.Setting.Large US multihospital database.Patients.We identified a total of 47,219 patients (age 18 years or older) who were admitted to the hospital for complicated skin and skin-structure infections from April 1, 2003, through March 31, 2004, and who received intravenous antibiotics during the first 2 hospital-days (ie, initial antibiotic therapy). Failure of therapy was defined as drainage, debridement, or receipt of other intravenous antibiotics at any subsequent time (except for changes to narrower-spectrum agents or any therapy change immediately before discharge). Predictors of failure of antibiotic therapy and mortality were examined using multivariate logistic regression. Analysis of covariance was used to estimate the impact of treatment failure on duration of intravenous antibiotic therapy, length of stay, and total inpatient charges.Results.For 10,782 admitted patients (22.8%), there was evidence of failure of initial antibiotic therapy. In multivariate analyses, treatment failure was associated with receipt of vasoactive medications during the first 2 hospital-days (odds ratio [OR], 1.66 [95% confidence interval {CI}, 1.19-2.31]), initiation of antibiotic therapy in the intensive care unit (OR, 1.53 [95% CI, 1.28-1.84]), and the patient's Charlson comorbidity index (OR per 1-point increase, 1.06 [95% CI, 1.04-1.08]); treatment failure was also was associated with a 3-fold increase in mortality (OR, 2.91 [95% CI, 2.34-3.62]). Compared with patients for whom initial treatment was successful, patients who experienced treatment failure received intravenous antibiotic therapy for a mean of 5.7 additional days, were hospitalized for a mean of 5.4 additional days, and incurred a mean of $5,285 (in 2003 dollars) in additional inpatient charges (all P <.01).Conclusion.Failure of initial antibiotic therapy in the treatment of complicated skin and skin-structure infections is associated with significantly worse clinical and economic outcomes.

scholarly journals Coalescent mastioditis as a complication of acute otitis media

2021 ◽  
Vol 51 (1) ◽  
Author(s):  
Ratna Dwi Restuti ◽  
Harim Priyono ◽  
Dora A Marpaung ◽  
Ayu Astria Sriyana ◽  
Rangga Rayendra Saleh
Keyword(s):  
Antibiotic Therapy ◽  
Otitis Media ◽  
Acute Otitis Media ◽  
Evidence Based ◽  
Antibiotic Administration ◽  
Intravenous Antibiotic ◽  
Literature Searches ◽  
Intravenous Antibiotics ◽  
Intracranial Complications ◽  
Common Infections

ABSTRACTBackground: Acute otitis media (AOM) is one of the most common infections in children. AOM disease can lead to complications such as coalescent mastoiditis. Mastoidectomy surgery in cases of coalescent mastoiditis in children is still a debate. Purpose: To convey the management of coalescent mastoiditis in pediatric patients as complication of AOM using an evidence-based literature search. Case Report: A 10-month patient with a diagnosis of AOM and coalescent mastoiditis, who was given antibiotic therapy and abscess drainage incision. Clinical question: In a child with coalescent mastoiditis as a complication of otitis media, could the disease be cured with intravena antiobitic therapy only without mastoidectomy operation? Review methods: Evidence-based literature searches through Pubmed, Proquest and Cochrane, were performed using the keywords mastoidectomy, antibiotics and coalescent mastoiditis. Result: The search resulted in 277 literatures, and 12 were relevant with the case, and two journals stating that in cases of uncomplicated coalescent mastoiditis, mastoidectomy operation could be delayed and intravenous antibiotic administration could be conducted by monitoring the patient's condition for 48 hours. Conclusion: Intravenous antibiotics are the main therapy in cases of coalescence mastoiditis accompanied by clinical monitoring for 48 hours. Additional mastoidectomy and other surgeries were performed in cases of clinical deterioration after intravenous antibiotic therapy, and in cases of intratemporal or intracranial complications.

scholarly journals Morbidity of peripherally inserted central catheters in pediatric complicated appendicitis

2014 ◽  
Vol 190 (1) ◽  
pp. 235-241 ◽  
Author(s):  
Jason P. Sulkowski ◽  
Lindsey Asti ◽  
Jennifer N. Cooper ◽  
Brian D. Kenney ◽  
Mehul V. Raval ◽  
...  
Keyword(s):  
Complicated Appendicitis ◽  
Peripherally Inserted Central Catheters ◽  
Central Catheters

The microbial biofilm composition on peripherally inserted central catheters: A comparison of polyurethane and hydrophobic catheters collected from paediatric patients

2020 ◽  
pp. 112972982093242
Author(s):  
Maddie Higgins ◽  
Li Zhang ◽  
Rebecca Ford ◽  
Jeremy Brownlie ◽  
Tricia Kleidon ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Microbial Communities ◽  
Bloodstream Infection ◽  
Dwell Time ◽  
Central Line ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Peripherally Inserted Central Catheters ◽  
Microbial Biofilm ◽  
Central Catheters

Background: Peripherally inserted central catheters are susceptible to microbial colonisation and subsequent biofilm formation, leading to central line–associated bloodstream infection, a serious peripherally inserted central catheter–related complication. Next-generation peripherally inserted central catheter biomaterials, such as hydrophobic materials (e.g. Endexo®), may reduce microbial biofilm formation or attachment, consequently reducing the potential for central line–associated bloodstream infection. Methods: Within a randomised controlled trial, culture-dependent and culture-independent methods were used to determine if the biomaterials used in traditional polyurethane peripherally inserted central catheters and hydrophobic peripherally inserted central catheters impacted microbial biofilm composition. This study also explored the impact of other clinical characteristics including central line–associated bloodstream infection, antibiotic therapy and dwell time on the microbial biofilm composition of peripherally inserted central catheters. Results: From a total of 32 patients, one peripherally inserted central catheter was determined to be colonised with Staphylococcus aureus, and on further analysis, the patient was diagnosed with central line–associated bloodstream infection. All peripherally inserted central catheters ( n = 17 polyurethane vs n = 15 hydrophobic) were populated with complex microbial communities, including peripherally inserted central catheters considered non-colonised. The two main microbial communities observed included Staphylococcus spp., dominant on the colonised peripherally inserted central catheter, and Enterococcus, dominant on non-colonised peripherally inserted central catheters. Both the peripherally inserted central catheter biomaterial design and antibiotic therapy had no significant impact on microbial communities. However, the diversity of microbial communities significantly decreased with dwell time. Conclusion: More diverse pathogens were present on the colonised peripherally inserted central catheter collected from the patient with central line–associated bloodstream infection. Microbial biofilm composition did not appear to be affected by the design of peripherally inserted central catheter biomaterials or antibiotic therapy. However, the diversity of the microbial communities appeared to decrease with dwell time.

Impact of ambulatory intravenous antibiotic therapy for children with pre-septal cellulitis

2010 ◽  
Vol 27 (Suppl 1) ◽  
pp. A9.2-A9
Author(s):  
Rossa Brugha
Keyword(s):  
Antibiotic Therapy ◽  
Health Economy ◽  
Study Group ◽  
Intravenous Antibiotic ◽  
Preseptal Cellulitis ◽  
Intravenous Antibiotic Therapy ◽  
Retrospective Audit ◽  
Intravenous Antibiotics ◽  
Significant Difference ◽  
The Impact

AimTo assess the impact of ambulatory intravenous antibiotic therapy for children with preseptal cellulitis.DesignRetrospective audit of 62 patients presenting with preseptal cellulitis over a 12 month period.SettingPaediatric Emergency Department, Chelsea and Westminster Hospital, London.Results62 patients identified from discharge summary coding. On review of medical notes 59 patients fulfilled criteria for preseptal cellulitis. Patients were attributed a modified severity score out of seven, based on signs and symptoms as previously1 19 patients (32%) were discharged home on oral antibiotics, one patient (2%) on topical therapy only, and 39 patients (66%) were started on intravenous antibiotics. There was a significant difference in symptom score between children started on oral versus intravenous antibiotic therapy (2.47 vs 3.21, p=0.021). Of the patients started on intravenous antibiotics, 22 children (56%) were managed on an ambulatory basis and 17 children (44%) were admitted. The management guideline allowed for ambulatory care, provided specified clinical factors were not present. The mean duration of antibiotic therapy was not different between the two groups (2.90 vs 2.75 days, p=0.79). Only three children in the study required imaging and there were no intracranial complications in either group. On a crude cost benefit analysis, the net fiscal benefit of a 3 day course of ambulatory versus inpatient intravenous therapy was calculated as £1672 per patient. For the study group, this represented a saving to the commissioning Trust of £36 784.ConclusionsIn this study group, children requiring intravenous antibiotics for uncomplicated preseptal cellulitis were safely managed on an ambulatory basis. This conveyed a considerable financial benefit to the health economy, in addition to a reduction in the burden of hospitalisation placed upon children and their families.

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