1
|
Ibrahim LF, Hopper SM, Connell TG, Daley AJ, Bryant PA, Babl FE. Evaluating an admission avoidance pathway for children in the emergency department: outpatient intravenous antibiotics for moderate/severe cellulitis. Emerg Med J 2017; 34:780-785. [PMID: 28978652 DOI: 10.1136/emermed-2017-206829] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/22/2017] [Accepted: 08/31/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Children with moderate/severe cellulitis requiring intravenous antibiotics are usually admitted to hospital. Admission avoidance is attractive but there are few data in children. We implemented a new pathway for children to be treated with intravenous antibiotics at home and aimed to describe the characteristics of patients treated on this pathway and in hospital and to evaluate the outcomes. METHODS This is a prospective, observational cohort study of children aged 6 months-18 years attending the ED with uncomplicated moderate/severe cellulitis in March 2014-January 2015. Patients received either intravenous ceftriaxone at home or intravenous flucloxacillin in hospital based on physician discretion. Primary outcome was treatment failure defined as antibiotic change within 48 hours due to inadequate clinical improvement or serious adverse events. Secondary outcomes include duration of intravenous antibiotics and complications. RESULTS 115 children were included: 47 (41%) in the home group and 68 (59%) in the hospital group (59 hospital-only, 9 transferred home during treatment). The groups had similar clinical features. 2/47 (4%) of the children in the home group compared with 8/59 (14%) in the hospital group had treatment failure (P=0.10). Duration of intravenous antibiotics (median 1.9 vs 1.8 days, P=0.31) and complications (6% vs 10%, P=0.49) were no different between groups. Home treatment costs less, averaging $A1166 (£705) per episode compared with $A2594 (£1570) in hospital. CONCLUSIONS Children with uncomplicated cellulitis may be able to avoid hospital admission via a home intravenous pathway. This approach has the potential to provide cost and other benefits of home treatment.
Collapse
Affiliation(s)
- Laila F Ibrahim
- Department of RCH@Home, The Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Sandy M Hopper
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Emergency, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Tom G Connell
- Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of General Medicine, Infectious Diseases Unit, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Andrew J Daley
- Department of General Medicine, Infectious Diseases Unit, The Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Microbiology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Penelope A Bryant
- Department of RCH@Home, The Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of General Medicine, Infectious Diseases Unit, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Franz E Babl
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Emergency, The Royal Children's Hospital, Parkville, Victoria, Australia
| |
Collapse
|
2
|
Park KH, Greenwood-Quaintance KE, Patel R. In vitro activity of ceftaroline against staphylococci from prosthetic joint infection. Diagn Microbiol Infect Dis 2016; 84:141-3. [PMID: 26602948 DOI: 10.1016/j.diagmicrobio.2015.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 10/14/2015] [Accepted: 10/18/2015] [Indexed: 01/20/2023]
Abstract
We tested the in vitro activity of ceftaroline by Etest against staphylococci recovered from patients with prosthetic joint infection, including 97 Staphylococcus aureus isolates (36%, oxacillin resistant) and 74 Staphylococcus epidermidis isolates (74%, oxacillin resistant). Ceftaroline inhibited all staphylococci at ≤0.5 μg/mL. The ceftaroline MIC(90/50) values for methicillin-susceptible S. aureus, methicillin-susceptible S. epidermidis, methicillin-resistant S. aureus, and methicillin-resistant S. epidermidis were 0.19/0.125, 0.094/0.047, 0.5/0.38, and 0.38/0.19 μg/mL, respectively. Based on these in vitro findings, ceftaroline should be further evaluated as a potential therapeutic option for the treatment of prosthetic joint infection caused by methicillin-susceptible and methicillin-resistant S. aureus and S. epidermidis.
Collapse
Affiliation(s)
- Kyung-Hwa Park
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, South Korea
| | - Kerryl E Greenwood-Quaintance
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905; Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN 55905.
| |
Collapse
|