Pediatric Outpatient Parenteral Antimicrobial Therapy (OPAT): Experience of Families During Implementation of the Program

Abstract

Abstract Background Experience with ambulatory intravenous antimicrobial therapy in pediatrics is reported since 1973. This modality avoids hospitalization or helps for early discharge in a patient who, in addition to antibiotics, has no other criteria to remain hospitalized. Even though it reduces the risks and costs that hospitalization entails and allows the patient to remain inserted in his family its use is not widespread in Latin America. We report the experience of families during the implementation of outpatient parenteral antibiotic therapy (OPAT) in pediatric oncologic patients at Solca Guayaquil. Methods A pilot program for outpatient parenteral antibiotic therapy (OPAT) was started in March 2022. We included patients with a permanent central venous access (port-a-cath) who were otherwise clinical stable (afebrile > 48h, increasing absolute neutrophil count (>500 in hematologic malignancies, >100 in solid tumors), no transfusion requirement) and completed a social questionnaire described previously (SUAU C, Thelma et al) with a score > 9. Patients had follow up with pediatric infectious diseases once a week during therapy and received a certificate of completion on their last day with a QR code to complete an anonymous online survey regarding their experience with the program. Results From March to November 2022 there were 6 patients enrolled. Their mean age 9.6 years, 3 (50%) were male and mean duration of therapy 7.7 days. Response rate was 100%. Ronald Mc. Donald's house hosted 5 (83%) patients while 1 (17%) was staying at home. There was 1 (16.7%) readmission 72h after completion of the program. No disfunction of catheter, secondary infection or deaths were reported. Return to regular activities was possible for 4 (67%) of patients. The experience was considered excellent, good or average in 3(50%), 2(33%) and 1(17%) cases. Quality of care during OPAT was perceived as exceeding expectations, meeting expectations and no opinion in 2(33%), 3(50%), and 1(17%) respectively. Support received by hospital staff was pondered excellent and good in 3 (50%) each. All of the patients agreed that OPAT was better than staying admitted however 1 (17%) declared that would not take this modality again (referred as "stressful"). Conclusion The newly implemented OPAT program was perceived overall as a positive experience for patients and their families, there were no major complications. The feedback provided helped to improve the logistics of the program.