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Five years of outpatient parenteral antibiotic therapy with ceftriaxone in the paediatric emergency department: what clinical features are associated with need for admission?
  1. Benjamin J Scally1,
  2. Gemma Buxton2,
  3. Jennifer K Smith3
  1. 1Emergency Department, Victoria Hospital Kirkcaldy, NHS Fife, Kirkcaldy, UK
  2. 2Immunology and Infectious Diseases Department, Royal Hospital for Children and Young People, Edinburgh, UK
  3. 3Emergency Department, Royal Hospital for Children and Young People, Edinburgh, UK
  1. Correspondence to Dr Jennifer K Smith, Royal Hospital for Children and Young People, Edinburgh, UK; Jennifer.K.Smith{at}nhslothian.scot.nhs.uk

Abstract

Background More children presenting to Emergency Departments (EDs) with acute infections are now directly referred for outpatient parenteral antibiotic therapy (OPAT). Sparse data exist on what clinical features in these children are associated with OPAT failure. We hypothesised that children who were younger or presented with systemic features of infection would be more likely to need admission.

Methods We conducted a service evaluation over a 5-year period (12 September 2015–12 September 2020) at a single UK tertiary centre paediatric ED formally known as the Royal Hospital for Sick Children Edinburgh. All children referred from the ED for OPAT with ceftriaxone were included. OPAT failure was defined as a decision by a senior clinician of need for admission. Univariate statistical testing and multivariate logistic regression modelling were performed.

Results 754 children received OPAT in the ED over a 5-year period. 95 children (13%) required admission for inpatient management. Need for admission was independently associated with having a positive blood culture (adjusted OR (aOR) 8.9; 95% CI 1.49 to 47; p=0.01) or an ultrasound performed (aOR 6.8; 95% CI 3.74 to 12.7; p<0.001). We observed no significant association between age and systemic features (fever, white cell count or C reactive protein) with need for admission in our multivariate analysis.

Conclusion In children presenting with acute infections to our paediatric ED who were deemed suitable by senior clinicians to be managed using OPAT with ceftriaxone, younger age (above 3 months) and the presence of systemic features were not independently associated with need for admission. Overall, our service was safe and no child came to harm from early ambulation during this evaluation.

  • pediatric emergency medicine
  • pediatrics
  • soft tissue infections

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Handling editor Gene Yong-Kwang Ong

  • Contributors JKS designed and coordinated the service evaluation, compiled patient data, edited the draft and approved the final manuscript. BJS compiled patient data, performed all data analyses, wrote the first draft and approved the final manuscript. GB compiled patient data, edited the draft and approved the final manuscript. All authors agree to be accountable for all aspects of the work. JKS was responsible for the conduct of this study and acts as guarantor for the overall content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.