Home Intravenous Antibiotic Treatment Research Articles

P084 The impact of the SARS-CoV-2 pandemic on people living with cystic fibrosis in Ireland: real-world data from the Irish cystic fibrosis registry

Objectives: The impact of the SARS-CoV-2 pandemic on people living with cystic fibrosis (PWCF) in Ireland was investigated by comparing the utilisation of regular hospital facilities in 2020, with data collected in 2019. Methods: All data were collated by the Cystic Fibrosis Registry of Ireland (CFRI). Comparisons were made between PWCF's access to regular hospital facilities utilised for the treatment and management of their condition prior to the outbreak of the pandemic in 2019, and preliminary data during the pandemic in 2020. A descriptive analysis of the differences between key outcome measure data was conducted. The outcome measures analysed were (i) the number and type of encounters, (ii) the number of virtual clinics, (iii) the number of pulmonary function tests (PFTs) carried out, (iv) the number of hospital admissions, and (v) the number of individuals receiving home intravenous antibiotic treatment. Results: In 2019, encounter data were recorded for 1,254 individuals, compared to 1,143 in 2020. Overall, fewer encounters took place in 2020 (5,346) than in 2019 (7,947). Decreases were observed across all in-person hospital encounter types in 2020, when compared with 2019 (annual review: 273 vs 747;day-unit review: 1,792 vs 2,864;drop-in: 115 vs 277;OPD appointment: 1,064 vs 3,289). However, since the outbreak of the pandemic, 1,696 virtual encounters occurred. Significantly, the number of PFTs carried out decreased by 58% in 2020 (2,283), when compared with 2019 (5,458). Of the 1,696 virtual encounters, only 183 (10.8%) saw PFTs carried out. Conclusion: Our analysis has shown a clear reduction in the utilisation of usually regular hospital resources by PWCF in 2020 when compared with 2019. In-person hospital encounters have decreased by 55% in total, highlighting the significant impact that the SARS-CoV-2 pandemic has had on PWCF.

Home Intravenous Antibiotic Treatment for a Patient with Opioid Use Disorder

Intravenous drug abusers may incur bloodstream infections, in particular those involving the heart valves, that often require extended courses of antibiotics, commonly on the order of six weeks. Conventional wisdom has dictated that even when patients are sufficiently well to not need ongoing hospitalization, it is unsafe to complete their antibiotic course in any setting other than in a closely supervised facility, even if this is contrary to their wishes. The assumption has been that such patients would be at risk of using their indwelling intravenous catheter for illicit purposes. Recent advances in the care of patients who suffer from addiction disorders suggest that when patients receive state-of-the-art addiction treatment, many may be able to continue their intravenous antibiotic course unsupervised, at home. This represents a departure from the parentalistic model of care of impaired patients who are prone to self-harm, moving towards a model that respects autonomy and trusts patients who are in recovery to continue their care in a manner that is self-beneficial.

WS6.6 A prospective multi centre study to examine the impact of home intravenous antibiotic treatment (H-IVAT) on carer well being

WS6.6 A prospective multi centre study to examine the impact of home intravenous antibiotic treatment (H-IVAT) on carer well being

Costs of Home Versus Inpatient Treatment for Fever and Neutropenia: Analysis of a Multicenter Randomized Trial

For patients with cancer who have febrile neutropenia, relative costs of home versus hospital treatment, including unreimbursed costs borne by patients and families, are poorly characterized. We estimated costs from a randomized trial of patients with low-risk febrile neutropenia for whom outpatient care was feasible, comparing inpatient treatment with discharge to home care after inpatient observation. We collected direct medical and self-reported indirect costs for 57 inpatient and 35 outpatient treatment episodes of patients enrolled in a randomized trial from 1996 through 2000. Charges from hospital bills were converted to costs using Medicare cost-to-charge ratios. Patients kept daily logs of out-of-pocket payments and time spent by informal caregivers providing care. Dollar amounts were standardized to June 2008. Mean total charges for the hospital arm were 49% higher than for the home treatment arm ($16,341 v $10,977; P < .01). Mean estimated total costs for the hospital arm were 30% higher ($10,143 v $7,830; P < .01). Inspection of sparse available data suggests that payments made were similar by treatment arm. Inpatients and their caregivers spent more out of pocket than their outpatient counterparts (mean, $201 v $74; P < .01). Informal caregivers for both treatment arms reported similar time caring and lost from work. Home intravenous antibiotic treatment was less costly than continued inpatient care for carefully selected patients with cancer having febrile neutropenia without significantly increased indirect costs or caregiver burden.

Home intravenous antibiotic treatment for intractable cholangitis in patients with biliary atresia following Kasai portoenterostomies

PurposePatients with biliary atresia (BA) treated with Kasai portoenterostomy may later develop intractable cholangitis (IC) that is unresponsive to routine conservative treatment. It may cause biliary cirrhosis and eventually hepatic failure with portal hypertension. Control of IC requires prolonged hospitalization for the administration of intravenous antibiotics. To reduce the hospitalization period, we designed a home intravenous antibiotic treatment (HIVA) which can be administered after initial inpatient treatment. In this study, we reviewed the effects of this treatment.MethodsWe reviewed medical records of 10 patients treated with HIVA for IC after successful Kasai portoenterostomies performed for BA between July 1997 and June 2009.ResultsThe duration of HIVA ranged from 8 to 39 months (median, 13.5 months). The median length of hospital stay was 5.7 days per month for conventional treatments to manage IC before HIVA and, 1.5 days per month (P = 0.012) after HIVA. The median amount of medical expenses per month was reduced by about one tenth with HIVA. One patient underwent liver transplantation due to uncontrolled esophageal variceal bleeding, but the other nine patients had acceptable hepatic function with native livers.ConclusionHIVA may be an effective primary treatment for IC after Kasai portoenterostomies for BA, and reduce length of hospital stay and medical expense.

Home intravenous antibiotic treatment of children with cystic fibrosis: clinical, quality of life and cost aspects

Home intravenous antibiotic treatment of children with cystic fibrosis: clinical, quality of life and cost aspects

Tratamiento antibiótico intravenoso domiciliario del absceso hepático: seguridad, eficacia y factores pronósticos de reingreso hospitalario

Few data exists in the literature about intravenous antibiotic treatment of hepatic abscess in hospital based care units. Our objectives were to analyze the efficacy and safety of intravenous antibiotic therapy and the predictors of hospital readmission. The study included all the patients admitted in our home care unit for intravenous antibiotic treatment of hepatic abscess from March 2006 to June 2009. We included 30 patients in the study. Five patients (16,6%) had phlebitis during treatment and none presented a major secondary effect. Mean size reduction of abscess during admission in our home care unit was 49,3% (36,6%). Nine (30%) patients were readmitted, 6 (20%) during admission at home and 3 (10%) along the year after. Four (13.3%) patients died along follow-up. Patients readmitted had a higher mean size of abscess at discharge from our home care unit as compared to the non readmitted ones (4,5 vs 1,5 cms P=0,001), besides a minor percentage of reduction of size (19% vs 64% P=0,001). Female patients were readmitted more frequently than male ones (77,8% vs 28,6% P=0,02), but they had minor scores of Barthel scale (75 vs. 92 P=0,01). Home intravenous antibiotic treatment of hepatic abscess seems to be a safe and effective alternative in most patients. The size and reduction of abscess at patient discharge, the female gender and dependence degree constituted the principal predictors of readmission.

Home intravenous antibiotic treatment for acute pulmonary exacerbations in cystic fibrosis - Is it good for the patient?

There is a worldwide drive for the home management of chronic respiratory diseases. With the widespread use of home intravenous (IV) treatment for cystic fibrosis (CF) pulmonary exacerbations (PExs), evidence pointing to an inferior outcome of care for home-treated patients in comparison to hospital-treated patients is a cause of concern. Currently, patients who self-administer IV antibiotics at home are provided with equipment and instructions on the use of antibiotics. Policies vary; but in most UK centers, these patients are then followed up by the multidisciplinary team only on days 1, 7 and 14 of the treatment course. We aimed to review the current published literature in search for evidence for the value and the shortfalls of self-administered IV treatment at home for acute PExs in CF patients in comparison to conventional hospital treatment. We searched the electronic database system Medline for published papers regarding studies comparing home- and hospital-based IV antibiotic treatment for both adult and pediatric CF patients. Sixteen studies were identified and grouped into those that showed a similar outcome between home and hospital treatment and those that showed an inferior outcome for home management. Most studies were retrospective or inadequately powered to provide clear answers. Ideally, outcome of care for home treatment should be at least equal to outcome for hospital treatment. Extensive efforts should be made to standardize therapies preserving the advantages of home management and addressing the perceived reasons for an inferior outcome. Until further studies provide definitive answers, treatment at home should be reserved for adequately selected patients and individualized depending on the unique settings of each CF center and specific patients' requirements. There is great need for a prospective randomized controlled trial comparing home and hospital treatments in order to clarify this matter.

Real life evaluation of intravenous antibiotic treatment in a paediatric cystic fibrosis centre: Outcome of home therapy is not inferior

Limited data exist on the efficacy and safety of home intravenous antibiotic (IV-AB) therapy for pulmonary infection specifically in children with cystic fibrosis (CF). We report on the outcome of IV-AB in the home vs hospital setting based on retrospective single centre patient data from 1999 to 2004 (age >5 and <18 years). Treatment location was chosen based on estimation of competence, adherence, social background and patient preference. Primary outcome parameter was change in FEV(1). Secondary outcome parameters were weight and IgG as well as occurrence of complications. One hundred and thirty-one treatment observations (TOs) were analysed for 47 patients. Mean age was 13.32 (+/-2.9) years and mean FEV(1) 65 (+/-19) % predicted. Fifty-four (41%) TO's were home and 77 (59%) were hospital treatments. Percent change in FEV(1) and weight gain was comparable in the 2 settings. Complications were rare in both groups. The outcome of IV-AB therapy for lung infection in children with CF was not inferior in the home compared to the hospital setting. In our centre, home IV-AB treatment is a valuable treatment option for children with CF.

Eficiencia del tratamiento antibiótico intravenoso domiciliario en la fibrosis quística

The objective of our study was to determine the costs saving with the implementing of a home intravenous antibiotic treatment (HIVAT) program for patients with cystic fibrosis and to compare it with the conventional system (inpatient). Consecutive patients in an adults cystic fibrosis unit were selected who received some days of HIVAT, between January 2002 and December 2004. For the analysis of costs saving of the HIVAT, we used the difference between the total costs of the avoided stay days and the costs generated by the domiciliary therapy (drugs, expendable equipment) and by the ambulatory medicine unit in case the patients were not hospitalized. All patients received a therapy with an intravenous antibiotic for a minimum of 14 days. All these data were provided by the accounting service of the hospital with the aid management Clinical Financier Program (GECLIF). 22 patients with cystic fibrosis needed 85 intravenous antibiotics treatments during the 3 years of the study, of which: 43 cycles were completely domiciliary, 14 inpatient and 28 were combined (hospital and home). The 71 cycles of HIVAT originated 909 days at home, with an average (standard deviation) of 12.80 (4.18) days and 43 treatments in ambulatory medicine unit. The home antibiotic treatments that originated greater cost (3,964.34 Euro) was meropenem (1 g/6 h) i.v. with linezolid (600 mg/12 h) via oral combination during 14 days, and in second place the association of ceftazidime, tobramycine and linezolid, whose cost in cycle of 14 days was of 2464.84 Euro. The average saving cost in the 3 years of study was of 2,647.29 Euro by each cycle of HIVAT and global 197,689.78 Euro. HIVAT obtained important sanitary costs saving and this was greater every year, not due to the increase of days at home, but due to the rising cost per day of hospital stays every new year.

426 Home intravenous (iv) antibiotic (ab) treatment: education to achieve complete patient autonomy

426 Home intravenous (iv) antibiotic (ab) treatment: education to achieve complete patient autonomy

Tratamiento antibiótico intravenoso domiciliario en las unidades de fibrosis quística de la Comunidad de Madrid

A descriptive study of the home intravenous antibiotic treatment (HIVAT) course in cystic fibrosis (CF) units of Madrid in an 18 month period. Different patient features were recorded, antibiotherapy, intravenous access, complications and their resolutions. We accessed the improvement of the pulmonary function, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) at the end of the treatment. For an 18 months period (January 2002-June 2003) the patients with CF who received HIVAT and fulfilled the previously fixed criteria were included. The next clinic variables were collected: age, sex, bacterial colonization of respiratory tree, pancreatic function and pulmonary function in steady phase, before and after HIAT. 56 patients, 31 male and 25 female, were given 90 courses of HIAT (34 patients received only one course). Mean age was 20.06 (8.07) years. 57.1% of the patients were colonized by Pseudomonas aeruginosa. The most frequently used antibiotics were ceftazidime and tobramycin. Courses of treatment lasted a mean of 4.08 (5.09) days inpatient and 11.89 (4.96) at home. In 87.7% of the course were used the intravenous cannulae, Port-a-cath in 6.7% and Venocath in 7.8%. The intravenous access was replaced, in the 64.4% of the cases, by the nurse of the CF Unit, in the 21.4% in the emergency room of the nearest hospital and in 11.9% in primary care center. Three occasions skin reactions were reported. The parameters of pulmonary function improved significatively after HIVAT. The HIVAT is a therapeutic option that, following predetermined inclusion criteria, has a low complication rate and improves pulmonary function.

Home and hospital antibiotic treatment prove similarly effective in cystic fibrosis.

Home intravenous antibiotic treatment has added to therapeutic options against Pseudomonas aeruginosa in cystic fibrosis (CF) patients leading to increased flexibility. A prospective clinical study was carried out to compare home and hospital iv antibiotic treatment in CF patients with chronic P. aeruginosa infection. Treatment courses were planned selectively, exacerbations were excluded. 28 consecutive hospital courses (group 1) were compared with 30 home care courses (group 2). Chest physiotherapy and nutrition therapy were carried on in both groups. Antibiotic treatment in both groups consisted of tobramycin and ceftazidime, with equal dosage and application. Groups were compared using clinical, inflammatory and microbiological parameters. There was a significant difference (p </= 0.05) in peripheral leukocyte counts before and after therapy in both groups. The same was true for forced expiratory volume in 1 sec (FEV(1); p </= 0.05), weight for height (p </= 0.005) and for Pseudomonas counts (p </= 0.005) in sputa. There was no statistical difference between the two groups for any of the parameters tested. It is concluded that, when exacerbations are excluded, home iv therapy is an effective therapeutic option in CF. Long-term comparison is still needed to effectively evaluate the pros and cons of home and hospital antibiotic treatment in CF.

Which children with fever and neutropenia can be safely treated as outpatients?

Which children with fever and neutropenia can be safely treated as outpatients?

Home intravenous antibiotic treatment for febrile episodes in immune-compromised pediatric patients.

The purpose of this work was to assess the feasibility of home intravenous antibiotic treatment (HIAT) for febrile episodes in immune-compromised (neutropenic, splenectomized), low-risk pediatric patients. Thirty hematology-oncology patients who presented to our emergency room from January 1993 to January 1995 and who suffered from a febrile episode and were considered at low risk for septic complications were immediately discharged on HIAT. Patients were followed for at least 3 weeks after recovery. Patients and parents were retrospectively questioned about adverse effects and about their degree of satisfaction with home treatment. Patients who required hospitalization during this period were considered unresponsive to HIAT and were analyzed for causes and adverse effects. Thirteen out of 60 (22%) febrile episodes, or eight out of 42 (19%) episodes of fever and neutropenia eventually led to hospitalization. Pseudomonas species infections were associated with the highest rate of unresponsiveness (88%). A central venous catheter infection developed in two cases following HIAT (two cases out of 640 days of therapy). No other complications were identified. No infection-related morbidity was observed. Patients and parents were highly satisfied with HIAT and wanted to use it again, if necessary. Immediate discharge on HIAT for low-risk pediatric immune-compromised patients suffering from a febrile episode is feasible, safe, and well accepted by patients and families. Patients who are found to have Pseudomonas infections should probably be hospitalized. Our results are preliminary and must be confirmed by a prospective, randomized trial before definite recommendations can be made.

Home intravenous antibiotic treatment for febrile episodes in immune‐compromised pediatric patients

Home intravenous antibiotic treatment for febrile episodes in immune‐compromised pediatric patients

Stability of aztreonam in a portable pump reservoir used for home intravenous antibiotic treatment (HIVAT).

The stability of the monocyclic beta-lactam antibiotic aztreonam in portable pump reservoirs was studied during storage at temperatures of -20 degrees C and +5 degrees C and during drug delivery at 37 degrees C. Three 100-ml drug reservoirs and three glass containers containing 60 mg/ml aztreonam were stored at -20 degrees C and 2-ml samples were analysed in the freshly prepared solution and after thawing at days 7, 21, 28, 70 and after 6 months of storage. A separate triplicate batch of 100-ml prefilled drug reservoirs and glass containers containing a similar aztreonam concentration (60 mg/ml) were refrigerated and tested immediately after preparation and daily for 8 days and after 70 days. Solutions of aztreonam in duplicate freshly prepared reservoirs were tested for stability when the solution was pumped at 37 degrees C over a 24-h period. All solutions were inspected for visual changes and tested for pH. Drug concentration was analysed by high-performance liquid chromatography. No colour changes or pH differences were observed in any of the solutions in the reservoirs of containers. No statistically significant decrease in aztreonam concentration could be detected after 6 months of storage at -20 degrees C. Aztreonam was stable at 5 degrees C for at least 8 days. A 24-h pumping period at 37 degrees C showed a 3.6% decrease in aztreonam concentration. Aztreonam at a concentration of 60 mg/ml in a pump reservoir is sufficiently stable to be used in home intravenous antibiotic treatment programmes.

Home intravenous antibiotic treatment of patients with cystic fibrosis.

We report one-year's experience of home iv antibiotic treatment in 31 patients with cystic fibrosis chronically colonized with Pseudomonas aeruginosa. The patients were aged 4-67 years and had a mild to severe disease as indicated by a Shwachman score of 46-95 (mean 77). Ninety-two courses of iv antibiotic therapy were given (mean 3.0 per patient). The mean duration of the courses was 15.4 days. The entire antibiotic course, except for the first dose, was administered at home in 70% of the courses. Most patients (94%) were given a combined treatment of a beta-lactam and an aminoglycoside, administered by the patients themselves or their parents. One inserted venous cannula could be used for the whole treatment period in 30% of the courses. There were no complications. The clinical and bacteriological outcome was good to excellent in 89% of the courses, with temporary eradication or semi-quantitative decrease of Pseudomonas growth in sputum. Lung function (forced expiratory volume at 1 s) and blood gases improved significantly (p less than 0.001) and p less than 0.01, respectively). Most patients were able to attend work or school as usual, and 96% of the patients preferred this type of treatment to hospitalization. Apart from the psychosocial advantages, the economical savings were substantial. In comparison to traditional treatments in hospital (21 patients, 41 courses) home iv antibiotic treatment was safe and effective.

Home intravenous antibiotic treatment in cystic fibrosis.

The prognosis for patients with cystic fibrosis who are colonised with Pseudomonas aeruginosa has improved as a result of the regular use of intravenous antibiotics; however, this necessitates long periods of hospitalisation. Home intravenous antibiotic treatment has potential advantages over hospital treatment. We describe our experience during the first 20 months of using a system of home intravenous antibiotic treatment in which a cystic fibrosis liaison sister has an essential role. Thirteen patients have received 40 courses of treatment. There were highly significant improvements in weight, respiratory function, and white cell count during home treatment. There was no significant difference in weight and forced expiratory volume in one second between the end of home treatment and the end of hospital treatment while forced vital capacity was better after home treatment. All patients preferred home treatment. The advantages of home visits by the cystic fibrosis liaison sister during treatment are emphasised.

Home intravenous antibiotic treatment in cystic fibrosis.

The experience of 1 year of home intravenous antibiotic treatment of patients with cystic fibrosis is reported. Ninety-two courses were given to 31 patients, aged 4-67 years (mean age, 21 years). All patients improved clinically and biochemically. The mean weight gain was significant (p less than 0.001). Blood PO2 increased significantly (p less than 0.01), and the forced expiratory volume in 1 sec in percentage of predicted values also improved significantly (p less than 0.001). The patients could attend school and work and wanted to have the same kind of home treatment at the next subclinical exacerbation. The possibility of avoiding hospitalization improved social life and made the patients feel responsible and therefore were cooperative with treatment before clinical deterioration.