Outpatient parenteral antimicrobial therapy: how young is too young?

ObjectiveTo report the use, and assess the efficacy and outcomes of outpatient parenteral antimicrobial therapy (OPAT) in neonates (≤28 days of age), compared with older infants (1-12 months of age).DesignA prospective 8-year observational study from September 2012 to September 2020.SettingThe Hospital-in-the-Home (HITH) programme of the Royal Children's Hospital Melbourne.PatientsNeonatal patients (≤28 days of age) were compared with older infants (1-12 months of age) receiving OPAT.InterventionsData were collected including demographics, diagnosis, type of venous access and antibiotic choice.Main outcome measuresSuccess of OPAT, antibiotic appropriateness, complications and readmission rate.ResultsThere were 76 episodes for which neonates were admitted to HITH for OPAT, and 405 episodes for older infants. Meningitis was the most common diagnosis in both groups (59% and 35%, respectively); the most frequently prescribed antibiotic was ceftriaxone for both groups (61% and 49%). A positive bacterial culture was less frequent in neonates (38% vs 53%, p=0.02). Vascular access complication rate was 19% in neonates compared with 13% in older infants (p=0.2) with no central line-associated bloodstream infection in either group. Rates of appropriate antibiotic prescribing were similarly high between groups (93% vs 90%, p=0.3). The OPAT course was successfully completed in 74 of 74 (100%) neonates and 380 of 396 (96%) older infants (p=0.09). The unplanned readmission rate was low: 4 of 76 (5%) neonates and 27 of 405 (7%) older infants.ConclusionsOPAT is a safe and effective way of providing antibiotics to selected clinically stable neonatal patients. While appropriate antibiotic use was common, improvements can still be made.