Hensey CC, et al. – Authors performed a comparison of clinical characteristics and outcomes between hospital and home treatment for pyelonephritis and meningitis in children. In addition, they identified factors influencing home treatment. Findings supported that these children could feasibly receive outpatient parenteral antimicrobial therapy (OPAT). This decision seemed influenced by age, treatment duration and fever. They suggest not considering any of these as a barrier to OPAT. The cost savings supported change in practice.

Methods

• Authors retrospectively identified children admitted to the hospital with pyelonephritis or proven and presumed bacterial meningitis from January 1, 2012, to December 31, 2013.
• Patients who received any OPAT (home group) received daily visits via the Hospital-in-the-Home (HITH) program; standard care was provided to the inpatients (hospital group).
• Hospital and home groups were compared regarding clinical and demographic features, length of stay, readmission rate and cost.

Results

• Authors identified 139 children with pyelonephritis and 70 with meningitis, of which 127 and 44 were potentially suitable for OPAT, respectively.
• Of these, OPAT was provided to 12 (9%) with pyelonephritis, contrasting with 29 (66%) with meningitis.
• Hospital- and home-treated patients were similar in terms of clinical features for either condition.
• In the hospital group, patients with meningitis were younger than those transferred to HITH (1 vs. 2 months; P = 0.01).
• Before transfer to HITH, all patients were afebrile.
• In this study, admissions for pyelonephritis were brief with inpatients having a shorter length of stay than home patients (median: 3 vs. 4.5 days; P = 0.002).
• All groups were comparable regarding unplanned readmission rates.
• A saving of AU$178,180 was observed with transfer to HITH.