Domiciliary parenteral antibiotic therapy: A prospective analysis of the last 12 years

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Peláez Cantero, A. Madrid Rodríguez, A.L. Urda Cardona, A. Jurado Ortiz" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M.J." "apellidos" => "Peláez Cantero" "email" => array:1 [ 0 => "pelaez_mariajose@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Madrid Rodríguez" ] 2 => array:2 [ "nombre" => "A.L." "apellidos" => "Urda Cardona" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Jurado Ortiz" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Gestión Clínica de Pediatría, Hospital Carlos Haya, Málaga, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento antimicrobiano parenteral domiciliario: análisis prospectivo de los últimos 12 años" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 479 "Ancho" => 1436 "Tamanyo" => 44516 ] ] "descripcion" => array:1 [ "en" => "Age distribution (in bar diagram) of patients who received OPAT." ] ] ] "textoCompleto" => "IntroductionTraditionally it has been thought that the administration of intravenous treatment required inpatient care; this situation started to change in 1974, when Rucker and Harrison<a class="elsevierStyleCrossRef" href="#bib0005">1</a> presented their clinical experience with outpatient antibiotic treatment in children with cystic fibrosis. Since then, various publications<a class="elsevierStyleCrossRefs" href="#bib0010">2,3</a> have shown that this is a safe and efficacious modality that benefits both the patient and the family members, and that it has a good cost–benefit relationship.<a class="elsevierStyleCrossRef" href="#bib0020">4</a>We define outpatient parenteral antimicrobial treatment (OPAT) as antibiotic, antifungal, or antiviral treatment delivered parenterally to patients who are not hospitalised, that is, who do not spend the night at the hospital, and consisting of at least 2 doses given on different days.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> The administration can be intravenous, intramuscular, or subcutaneous. The latter, while used infrequently, has been described in adult patients receiving palliative care, and requires putting in a request for compassionate use of the selected drug with the Agencia Española de Medicamentos (Spanish Medicines Agency). The term most frequently used to refer to this internationally is the acronym OPAT, which reflects the ambulatory approach to health care delivery of the United States model. In Spain we find the term “home intravenous antimicrobial therapy” (HIVAT) more suitable to refer to the integral at-home treatment of infectious disease in the patient.There are several models for outpatient treatment administration that adhere to published guidelines for adults.<a class="elsevierStyleCrossRefs" href="#bib0030">6,7</a> The setting where the treatment is provided can be the home, day hospitals, freestanding infusion centres, emergency care and observation units, outpatient services, residential facilities and even the work place; and the treatment can be administered by health professionals or self-administered, that is, delivered by the patient or the carers.There are few publications on this subject in Spain, especially in the paediatric field, and the main purpose of this article is to present our experience as a hospital at home unit (HHU), which is part of the paediatrics department, in parenteral antimicrobial treatment administered at home to paediatric patients with chronic underlying diseases, over the span of 12 years, and to assess its efficacy and safety.Patients and methodsStudy designWe have conducted a prospective descriptive analysis, obtaining data from all patients served at a paediatric HHU who received parenteral treatment at home.Team in chargeOur HHU team consists of 2 paediatricians and 2 specialised nurses who work in collaboration with social workers and primary care.The unit provides 7h of physician coverage and 12h of nursing coverage on weekdays. Patients are seen in the emergency department of our hospital at all other times.Sources of patient referralsOur purpose as a HHU is to avoid or shorten hospital stays, so our patients are selected from the inpatient paediatric floor or from outpatient services.The physician in charge makes a referral to our unit, including a clinical summary and information on the antimicrobial treatment the patient is receiving and its planned duration.PatientsTo propose this type of treatment, the paediatrician has to determine that the patient has an infectious disease requiring parenteral treatment and that hospitalisation is not needed to control the infection.Patients were selected according to the inclusion and exclusion criteria detailed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The physical and mental condition of the carers was assessed by means of an interview with the HHU team.Patient and carer trainingHHU nurses carry out the training. Its duration must be such that the patient and the carer feel confident and fully familiarised with the technique.Should the patient need protracted treatment, as was the case of most patients included in the study, the patient and carer are taught how to self-administer the corresponding medication and how to evaluate potential complications. The patient stays in the hospital during the training period. After proper training in technique, ensuring that the patient or carer can perform it correctly, and the administration of at least one initial intravenous dose at the hospital to watch for potential anaphylactic reactions, the patient is discharged to the home to continue treatment.In case of shorter treatments, the HHU nursing staff will perform home visits to administer the treatment, so the patient and carers are only trained in how to assess for complications.Study variablesWe gathered data on the following variables for each patient included in the study: age, sex, hospital area from which patient was referred (outpatient or inpatient services), underlying disease, condition requiring parenteral treatment, length of training, type of vascular access, isolated pathogen, administered antimicrobial, duration of treatment, secondary adverse effects, complications during the process, and hospital readmission.Antibiotic choice, dosage, and infusion systemThe HHU paediatricians and the medical specialist in charge decide on the most appropriate treatment for the referred patient. As much as possible, the team selects drugs with longer half-lives, lower toxicity, and requiring less manipulation by the patient.MonitoringOnce the patient is home and while treatment is ongoing, the team talks on the phone with the carers daily and, if needed, arranges home visits by a nurse or by a nurse and a paediatrician.Data analysisWe retrieved the data from a prospective database and did a descriptive statistical analysis. We analysed all the data with the Microsoft Excel application (for Mac): 2011.ResultsA total of 55 patients (60% male) were included in the period under study. Of all patients, 35 (63.6%) had more than one episode, adding up to a total of 163 episodes of home parenteral treatment.The mean age of our patients for each episode was 11.1 years (SD 4.85, range 4 months to 19 years) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>In 126 episodes (77.3%), patients were referred from hospital outpatient services, especially from pulmonology (97% of patients referred from outpatient). For the remaining 37 episodes (22.7%), the patients were referred from inpatient wards, most of them from oncology (66% of patients referred from inpatient). The patients that could benefit most from this type of care are found in these settings: patients with chronic diseases that are going to need extended treatment.The mean length of patient and carer training was 218min per episode.Of all patients, 27 (49%) had cystic fibrosis (CF), 22 (40%) some type of cancer, 3 (5.6%) gastrointestinal diseases, 1 (1.8%) HIV infection, 1 (1.8%) bronchopulmonary dysplasia, and 1 (1.8%) had hyper IgM syndrome.The episodes listed in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> were treated at the patient's home.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The most frequently used type of vascular access was peripheral access (94.5%); central access was only used in 4 (2.5%) patients who were chronically ill and already had this device. Treatment was delivered intramuscularly in 5 (3%) episodes.The causative agent was identified in 64 (39.2%) episodes (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). The pathogen was not isolated in the remaining cases, in 4 because the culture was negative and in 95 because no culture was done.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>The most frequently administered antibiotics were amikacin (n=43), ceftazidime (n=41), cefepime (n=40), teicoplanin (n=26), cefotaxime (n=12), tobramycin (n=20), ceftriaxone (n=5) and vancomycin (n=4). A combination of 2 or more antimicrobials was used in 105 episodes (63.2%), and the most common combination was ceftazidime with amikacin.The mean duration of home treatment in the included patients was of 11.05 days (SD 5.82, range 1–25 days), and the cumulative number of treatment days was 1972 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). We did an estimated cost-analysis based on the costs of public health services in centres overseen by the Servicio Andaluz de Salud (Health Service of Andalusia), and found that the inclusion of patients in this programme could have saved up to 95% of the cost of conventional inpatient treatment.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>The documented complications that arose during treatment were extravasation or accidental displacement of the peripheral line in 12 (7.2%) episodes, development of phlebitis in 5 (3%), exanthema or urticaria concurrent with drug administration in 5 (3%), poor technique in antimicrobial administration due to incorrect flushing of the device in 1 (0.6%), and breakdown of the infusion pump in 1 (0.6%) episode.While the patients received care from our unit, 16 (9.8%) episodes required admission to the hospital, 4 (2.5%) of them due to poor evolution of the infectious process despite treatment, and 12 (7.4%) due to an exacerbation of the underlying disease.Treatment was completed in the home in 147 episodes (90.2%), after which patients were discharged from our unit because of their favourable clinical outcome.No deaths occurred during home treatment.DiscussionOPAT is a proven efficacious and safe alternative to conventional hospitalisation of patients with bacterial infections.<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a> In our setting, the HHU is the ideal care service to implement and monitor it. Here we present a broad and recent series of paediatric patients with underlying chronic disease who received parenteral treatment at home.The disease distribution found in our study diverges from that described in other series. In our study, 74.5% of the patients had respiratory tract superinfections, contrary to what has been reported in other publications in which osteoarticular<a class="elsevierStyleCrossRefs" href="#bib0050">10,11</a> or soft tissue<a class="elsevierStyleCrossRef" href="#bib0060">12</a> infections were more prevalent. This is due to the chronic underlying disease in our patients, most of whom suffered from CF.We wish to highlight that carers administered the treatment to most patients, which is why we could use drugs with a schedule of several doses a day. Under different arrangements, the patient needs to visit the emergency department daily for a nurse to administer the treatment,<a class="elsevierStyleCrossRef" href="#bib0060">12</a> or the HHU travels daily to the home to administer it,<a class="elsevierStyleCrossRef" href="#bib0065">13</a> so the most widely used drugs are those with a single-daily-dose schedule.The antibiotics used most frequently these years were the same as those used by other groups, with third-generation cephalosporins and aminoglycosides being the most widely used. This is because most courses of antibiotherapy administered in the home were used in patients with CF.As for the type of vascular access used, our data were consistent with most of the published literature<a class="elsevierStyleCrossRef" href="#bib0070">14</a> that establishes peripheral access as the first choice. In case of complicated vascular access or in patients who are receiving frequent courses of antibiotics, a peripherally inserted central catheter or a conventional central catheter are used, although there is an increasing number of publications that propose the peripherally inserted central line as the first-choice route, presenting it as a safer, more effective, and less costly option.<a class="elsevierStyleCrossRefs" href="#bib0075">15,16</a>In our study, the rate of complications was 9.8%, far lower than rates reported in the literature.<a class="elsevierStyleCrossRefs" href="#bib0055">11,17,18</a> Consistent with the literature, the most frequent complications were extravasation or accidental displacement of the peripheral line, although the percentage was low in our sample, probably because most of our patients are older than 5 years. We did not register any other complications that, while infrequent, are reported in other studies, like neutropenia or fever.<a class="elsevierStyleCrossRef" href="#bib0085">17</a>Our rate of episodes with favourable clinical outcome (90.2%) is very similar to what has been reported in the literature up to date.<a class="elsevierStyleCrossRefs" href="#bib0055">11,18</a> We should note that only 16 (9.8%) patients in our study required readmission, and that 12 (7.4%) of them required it unexpectedly for reasons related to their underlying disease, and not to therapeutic failure for the infection for which they were being treated.Home administration of the prescribed treatment has several advantages. The most obvious advantage for patients is that they remain in their environment, and some can resume their school activities. In addition, evidence from various published studies show that this type of therapy increases the psychological wellbeing of paediatric patients,<a class="elsevierStyleCrossRef" href="#bib0095">19</a> improves the physical, social, and emotional quality of life of adults,<a class="elsevierStyleCrossRef" href="#bib0100">20</a> and results in a reduction in the number of nosocomial infections.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> The advantage over hospitalisation for providers is that they can treat patients in a pleasanter environment for latter, improving provider–patient communication and rapport. Lastly, it is advantageous for the administration, as it has been proven that OPAT results in fewer overnight stays at the hospital and lower costs for the hospital,<a class="elsevierStyleCrossRefs" href="#bib0110">22,23</a> in addition to increasing patient satisfaction.Although at-home OPAT administered by the carers has been established as a safe, efficacious, practical, and cost-effective treatment option,<a class="elsevierStyleCrossRef" href="#bib0120">24</a> and offers an alternative to patients who wish to return to their normal environment, which was supported by the results of our study, there are also disadvantages and risks. Some of these include the decreased ability to monitor the patient properly at home, the lower degree of supervision, the feelings of insecurity of carers at the beginning of treatment, and the medical complications that could arise in relation to the treatment. Although these are inherent risks in OPAT, our unit minimises them by the strict selection of patients and carers, offering intensive, problem-solving training during the hospital stay, and providing a quick means of communication between carers and the team in charge through the phone. Thus, the essential factors for a successful OPAT programme are: to have the appropriate infrastructure, to make a careful selection of patients, to have a multidisciplinary staff with experience both in at-home care delivery and in the diagnosis and treatment of infectious diseases, to provide the necessary information and training, and to properly monitor the patient who is receiving this type of treatment. The hospital must guarantee continued care 24h a day to address any complications that may arise, and ideally there would be HHU coverage for most of these hours. Also, the HHU should work in close collaboration with the referring provider and with the infectious disease and pharmacy services.There are a growing number of review studies on the home administration of parenteral treatment in children with acute disease such as osteomyelitis,<a class="elsevierStyleCrossRef" href="#bib0125">25</a> cellulitis,<a class="elsevierStyleCrossRef" href="#bib0130">26</a> pneumonia,<a class="elsevierStyleCrossRef" href="#bib0135">27</a> or pyelonephritis.<a class="elsevierStyleCrossRef" href="#bib0140">28</a>Our study has the following limitations: it is a single-centre study and the majority of referrals we receive are CF patients. These limitations may have resulted in biases in our analysis, which could be brought to light when comparing our results with those of other published studies.This review and analysis has allowed us to identify areas where we are lacking, providing an incentive to try to design protocols based on scientific evidence and our clinical experience in the near future that would include not only patients with underlying chronic disease, but also patients with acute disease that could receive parenteral antimicrobial treatment at home.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres360538" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objetives" 2 => "Patients and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec340401" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres360537" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivo" 2 => "Pacientes y método" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec340400" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:9 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Team in charge" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Sources of patient referrals" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Patients" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Patient and carer training" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Study variables" ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Antibiotic choice, dosage, and infusion system" ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Monitoring" ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Data analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0060" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0065" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-03-30" "fechaAceptado" => "2013-05-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec340401" "palabras" => array:3 [ 0 => "Outpatient parenteral antimicrobial therapy" 1 => "Home therapy" 2 => "Paediatric infections" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec340400" "palabras" => array:5 [ 0 => "Tratamiento antimicrobiano domiciliario intravenoso" 1 => "Tratamiento antimicrobiano parenteral ambulatorio" 2 => "Tratamiento domiciliario" 3 => "Intravenoso" 4 => "Infección" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "ObjetivesParenteral antibiotic treatment has been classically developed in hospitals and is considered as a hospital procedure. The development of Hospital at Home Units (HHU) has led to an increase in outpatient parenteral antibiotic therapy (OPAT) in paediatric patients. The objective of this study is to describe our experience, as an HHU integrated within a Paediatric Department, in home antimicrobial therapy over a period of 12 years. Patients and methodsThis prospective and descriptive study included every patient with a disease requiring parenteral antimicrobial therapy who was admitted to our HHU from January 2000 to December 2012. ResultsDuring the study there were 163 cases on OPAT. The mean age of the patients was 11.1 years, and the sample group was comprised of 33 males and 22 females. The main sources of the treated infections were respiratory tract (76%), catheter-related bloodstream (9.2%), and urinary tract infections (5.5%). Amikacin was the most widely used antibiotic. Almost all treatments (96.6%) were via an intravenous route. Catheter-associated complications were more common than drug-associated complications. Successful at-home treatment was observed in 90.2% of cases. ConclusionsOPAT is a good and safe alternative in many paediatric diseases." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "ObjetivoClásicamente la administración de tratamientos intravenosos se ha asociado a la necesidad de ingreso hospitalario. A partir de la formación de unidades de hospitalización a domicilio (UHD) se han extendido e incrementado el número de tratamientos antimicrobianos administrados por vía parenteral en pacientes pediátricos en su domicilio. El objetivo de este artículo es exponer la experiencia en tratamientos parenterales en domicilio en una UHD pediátrica durante un periodo de 12 años. Pacientes y métodoSe realiza un estudio descriptivo, prospectivo. Se incluyeron en el estudio a todos los pacientes atendidos en nuestra UHD por enfermedad subsidiaria de tratamiento parenteral desde enero de 2000 hasta diciembre de 2012. ResultadosSe han instaurado 163 tratamientos parenterales en domicilio. La edad media fue de 11,1 años. Por sexos, 40% mujeres y 60% varones. Las infecciones tratadas han sido, en su mayoría, sobreinfecciones respiratorias (76%), infecciones del catéter central (9,2%) e infecciones del tracto urinario (5,5%). El antibiótico más utilizado ha sido la amikacina. El 96,9% de los tratamientos fue intravenoso. La complicación más frecuente ha sido la extravasación o pérdida de vía (7,4%). Se completó el tratamiento en domicilio en un 90,2% de los casos. ConclusionesLa administración de tratamientos parenterales en domicilio es una opción asistencial buena y segura en pacientes pediátricos." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Peláez Cantero MJ, Madrid Rodríguez A, Urda Cardona AL, Jurado Ortiz A. Tratamiento antimicrobiano parenteral domiciliario: análisis prospectivo de los últimos 12 años. Anal Pediatr (Barc). 2014;81:86–91." ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 479 "Ancho" => 1436 "Tamanyo" => 44516 ] ] "descripcion" => array:1 [ "en" => "Age distribution (in bar diagram) of patients who received OPAT." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 863 "Ancho" => 1653 "Tamanyo" => 89380 ] ] "descripcion" => array:1 [ "en" => "Number of outpatient treatment episodes administered at home and number of the hospitalisation days per year." ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inclusion criteria \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Medically stable patient \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chronic underlying disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-progressing infection \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Family support \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Carers are physically and mentally able to provide treatment in the home \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Home address within the HHU service area \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Having a telephone, running water, and refrigerator \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Voluntary consent for at-home treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Signed informed consent \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Exclusion criteria \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Infection can be treated orally \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Need for some other inpatient treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab538870.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Patient inclusion and exclusion criteria." ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "CMV: cytomegalovirus; CF: cystic fibrosis; VP shunt: ventriculo-peritoneal shunt." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Types of episodes (n=163)</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Respiratory tract infections (n=125)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Respiratory tract superinfection in CF patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">124 cases \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pneumonia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 cases \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Central catheter infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 cases \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Genitourinary infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 cases \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Soft-tissue infections (n=4)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Varicella \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 case \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Herpes zoster \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 cases \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Celullitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 case \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Febrile neutropenia in oncology patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 cases \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Digestive system infections (n=2)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cholangitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 cases \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CMV infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 case \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bacteraemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 case \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fever without a source \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 case \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VP shunt infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 case \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab538868.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Types of episodes treated at home." ] ] 4 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "MRSA, methicillin-resistant Staphylococcus aureus; MSSA, methicillin-sensitive Staphylococcus aureus." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Microbiology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">No. of episodes (% of 163) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sputum culture \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 (25.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Polymicrobial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MSSA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MRSA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pseudomonas ssp. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Blood culture \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (9.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gram-positive<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gram-negative<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Other<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urine culture \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (4.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Klebsiella oxytoca \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Proteus mirabilis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Candida parapsilosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unidentified<a class="elsevierStyleCrossRef" href="#tblfn0020">d</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99 (60.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab538869.png" ] ] ] "notaPie" => array:4 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Includes Staphylococcus epidermidis (n=5), Streptococcus pyogenes (n=1), coagulase-negative (n=2)." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Includes Klebsiella spp. (n=2), Serratia marcescens (n=2), Acinetobacter spp. (n=1)." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "Includes Candida parapsilosis (n=2)." ] 3 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "d" "nota" => "Unidentified: negative culture (n=4) or culture was not done (n=95)." ] ] ] "descripcion" => array:1 [ "en" => "Microbiology results of the 163 episodes of home parenteral treatment." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outpatient intravenous medications 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Domiciliary parenteral antibiotic therapy: A prospective analysis of the last 12 years

Tratamiento antimicrobiano parenteral domiciliario: análisis prospectivo de los últimos 12 años

M.J. Peláez Cantero

Corresponding author

pelaez_mariajose@hotmail.com

Corresponding author.

, A. Madrid Rodríguez, A.L. Urda Cardona, A. Jurado Ortiz

Unidad de Gestión Clínica de Pediatría, Hospital Carlos Haya, Málaga, Spain

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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Age distribution &#40;in bar diagram&#41; of patients who received OPAT&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Traditionally it has been thought that the administration of intravenous treatment required inpatient care&#59; this situation started to change in 1974&#44; when Rucker and Harrison<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> presented their clinical experience with outpatient antibiotic treatment in children with cystic fibrosis&#46; Since then&#44; various publications<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> have shown that this is a safe and efficacious modality that benefits both the patient and the family members&#44; and that it has a good cost&#8211;benefit relationship&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We define outpatient parenteral antimicrobial treatment &#40;OPAT&#41; as antibiotic&#44; antifungal&#44; or antiviral treatment delivered parenterally to patients who are not hospitalised&#44; that is&#44; who do not spend the night at the hospital&#44; and consisting of at least 2 doses given on different days&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The administration can be intravenous&#44; intramuscular&#44; or subcutaneous&#46; The latter&#44; while used infrequently&#44; has been described in adult patients receiving palliative care&#44; and requires putting in a request for compassionate use of the selected drug with the Agencia Espa&#241;ola de Medicamentos &#40;Spanish Medicines Agency&#41;&#46; The term most frequently used to refer to this internationally is the acronym OPAT&#44; which reflects the ambulatory approach to health care delivery of the United States model&#46; In Spain we find the term &#8220;home intravenous antimicrobial therapy&#8221; &#40;HIVAT&#41; more suitable to refer to the integral at-home treatment of infectious disease in the patient&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">There are several models for outpatient treatment administration that adhere to published guidelines for adults&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> The setting where the treatment is provided can be the home&#44; day hospitals&#44; freestanding infusion centres&#44; emergency care and observation units&#44; outpatient services&#44; residential facilities and even the work place&#59; and the treatment can be administered by health professionals or self-administered&#44; that is&#44; delivered by the patient or the carers&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">There are few publications on this subject in Spain&#44; especially in the paediatric field&#44; and the main purpose of this article is to present our experience as a hospital at home unit &#40;HHU&#41;&#44; which is part of the paediatrics department&#44; in parenteral antimicrobial treatment administered at home to paediatric patients with chronic underlying diseases&#44; over the span of 12 years&#44; and to assess its efficacy and safety&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design</span><p id="par0025" class="elsevierStylePara elsevierViewall">We have conducted a prospective descriptive analysis&#44; obtaining data from all patients served at a paediatric HHU who received parenteral treatment at home&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Team in charge</span><p id="par0030" class="elsevierStylePara elsevierViewall">Our HHU team consists of 2 paediatricians and 2 specialised nurses who work in collaboration with social workers and primary care&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The unit provides 7<span class="elsevierStyleHsp" style=""></span>h of physician coverage and 12<span class="elsevierStyleHsp" style=""></span>h of nursing coverage on weekdays&#46; Patients are seen in the emergency department of our hospital at all other times&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Sources of patient referrals</span><p id="par0040" class="elsevierStylePara elsevierViewall">Our purpose as a HHU is to avoid or shorten hospital stays&#44; so our patients are selected from the inpatient paediatric floor or from outpatient services&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The physician in charge makes a referral to our unit&#44; including a clinical summary and information on the antimicrobial treatment the patient is receiving and its planned duration&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Patients</span><p id="par0050" class="elsevierStylePara elsevierViewall">To propose this type of treatment&#44; the paediatrician has to determine that the patient has an infectious disease requiring parenteral treatment and that hospitalisation is not needed to control the infection&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Patients were selected according to the inclusion and exclusion criteria detailed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The physical and mental condition of the carers was assessed by means of an interview with the HHU team&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Patient and carer training</span><p id="par0065" class="elsevierStylePara elsevierViewall">HHU nurses carry out the training&#46; Its duration must be such that the patient and the carer feel confident and fully familiarised with the technique&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Should the patient need protracted treatment&#44; as was the case of most patients included in the study&#44; the patient and carer are taught how to self-administer the corresponding medication and how to evaluate potential complications&#46; The patient stays in the hospital during the training period&#46; After proper training in technique&#44; ensuring that the patient or carer can perform it correctly&#44; and the administration of at least one initial intravenous dose at the hospital to watch for potential anaphylactic reactions&#44; the patient is discharged to the home to continue treatment&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In case of shorter treatments&#44; the HHU nursing staff will perform home visits to administer the treatment&#44; so the patient and carers are only trained in how to assess for complications&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Study variables</span><p id="par0080" class="elsevierStylePara elsevierViewall">We gathered data on the following variables for each patient included in the study&#58; age&#44; sex&#44; hospital area from which patient was referred &#40;outpatient or inpatient services&#41;&#44; underlying disease&#44; condition requiring parenteral treatment&#44; length of training&#44; type of vascular access&#44; isolated pathogen&#44; administered antimicrobial&#44; duration of treatment&#44; secondary adverse effects&#44; complications during the process&#44; and hospital readmission&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Antibiotic choice&#44; dosage&#44; and infusion system</span><p id="par0085" class="elsevierStylePara elsevierViewall">The HHU paediatricians and the medical specialist in charge decide on the most appropriate treatment for the referred patient&#46; As much as possible&#44; the team selects drugs with longer half-lives&#44; lower toxicity&#44; and requiring less manipulation by the patient&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Monitoring</span><p id="par0090" class="elsevierStylePara elsevierViewall">Once the patient is home and while treatment is ongoing&#44; the team talks on the phone with the carers daily and&#44; if needed&#44; arranges home visits by a nurse or by a nurse and a paediatrician&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Data analysis</span><p id="par0095" class="elsevierStylePara elsevierViewall">We retrieved the data from a prospective database and did a descriptive statistical analysis&#46; We analysed all the data with the Microsoft Excel application &#40;for Mac&#41;&#58; 2011&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Results</span><p id="par0100" class="elsevierStylePara elsevierViewall">A total of 55 patients &#40;60&#37; male&#41; were included in the period under study&#46; Of all patients&#44; 35 &#40;63&#46;6&#37;&#41; had more than one episode&#44; adding up to a total of 163 episodes of home parenteral treatment&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The mean age of our patients for each episode was 11&#46;1 years &#40;SD 4&#46;85&#44; range 4 months to 19 years&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">In 126 episodes &#40;77&#46;3&#37;&#41;&#44; patients were referred from hospital outpatient services&#44; especially from pulmonology &#40;97&#37; of patients referred from outpatient&#41;&#46; For the remaining 37 episodes &#40;22&#46;7&#37;&#41;&#44; the patients were referred from inpatient wards&#44; most of them from oncology &#40;66&#37; of patients referred from inpatient&#41;&#46; The patients that could benefit most from this type of care are found in these settings&#58; patients with chronic diseases that are going to need extended treatment&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The mean length of patient and carer training was 218<span class="elsevierStyleHsp" style=""></span>min per episode&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Of all patients&#44; 27 &#40;49&#37;&#41; had cystic fibrosis &#40;CF&#41;&#44; 22 &#40;40&#37;&#41; some type of cancer&#44; 3 &#40;5&#46;6&#37;&#41; gastrointestinal diseases&#44; 1 &#40;1&#46;8&#37;&#41; HIV infection&#44; 1 &#40;1&#46;8&#37;&#41; bronchopulmonary dysplasia&#44; and 1 &#40;1&#46;8&#37;&#41; had hyper IgM syndrome&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The episodes listed in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> were treated at the patient&#39;s home&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">The most frequently used type of vascular access was peripheral access &#40;94&#46;5&#37;&#41;&#59; central access was only used in 4 &#40;2&#46;5&#37;&#41; patients who were chronically ill and already had this device&#46; Treatment was delivered intramuscularly in 5 &#40;3&#37;&#41; episodes&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The causative agent was identified in 64 &#40;39&#46;2&#37;&#41; episodes &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; The pathogen was not isolated in the remaining cases&#44; in 4 because the culture was negative and in 95 because no culture was done&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">The most frequently administered antibiotics were amikacin &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43&#41;&#44; ceftazidime &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>41&#41;&#44; cefepime &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41;&#44; teicoplanin &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;&#44; cefotaxime &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&#44; tobramycin &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&#44; ceftriaxone &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41; and vancomycin &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&#46; A combination of 2 or more antimicrobials was used in 105 episodes &#40;63&#46;2&#37;&#41;&#44; and the most common combination was ceftazidime with amikacin&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The mean duration of home treatment in the included patients was of 11&#46;05 days &#40;SD 5&#46;82&#44; range 1&#8211;25 days&#41;&#44; and the cumulative number of treatment days was 1972 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; We did an estimated cost-analysis based on the costs of public health services in centres overseen by the Servicio Andaluz de Salud &#40;Health Service of Andalusia&#41;&#44; and found that the inclusion of patients in this programme could have saved up to 95&#37; of the cost of conventional inpatient treatment&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">The documented complications that arose during treatment were extravasation or accidental displacement of the peripheral line in 12 &#40;7&#46;2&#37;&#41; episodes&#44; development of phlebitis in 5 &#40;3&#37;&#41;&#44; exanthema or urticaria concurrent with drug administration in 5 &#40;3&#37;&#41;&#44; poor technique in antimicrobial administration due to incorrect flushing of the device in 1 &#40;0&#46;6&#37;&#41;&#44; and breakdown of the infusion pump in 1 &#40;0&#46;6&#37;&#41; episode&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">While the patients received care from our unit&#44; 16 &#40;9&#46;8&#37;&#41; episodes required admission to the hospital&#44; 4 &#40;2&#46;5&#37;&#41; of them due to poor evolution of the infectious process despite treatment&#44; and 12 &#40;7&#46;4&#37;&#41; due to an exacerbation of the underlying disease&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Treatment was completed in the home in 147 episodes &#40;90&#46;2&#37;&#41;&#44; after which patients were discharged from our unit because of their favourable clinical outcome&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">No deaths occurred during home treatment&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0170" class="elsevierStylePara elsevierViewall">OPAT is a proven efficacious and safe alternative to conventional hospitalisation of patients with bacterial infections&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> In our setting&#44; the HHU is the ideal care service to implement and monitor it&#46; Here we present a broad and recent series of paediatric patients with underlying chronic disease who received parenteral treatment at home&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">The disease distribution found in our study diverges from that described in other series&#46; In our study&#44; 74&#46;5&#37; of the patients had respiratory tract superinfections&#44; contrary to what has been reported in other publications in which osteoarticular<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a> or soft tissue<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> infections were more prevalent&#46; This is due to the chronic underlying disease in our patients&#44; most of whom suffered from CF&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">We wish to highlight that carers administered the treatment to most patients&#44; which is why we could use drugs with a schedule of several doses a day&#46; Under different arrangements&#44; the patient needs to visit the emergency department daily for a nurse to administer the treatment&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> or the HHU travels daily to the home to administer it&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> so the most widely used drugs are those with a single-daily-dose schedule&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">The antibiotics used most frequently these years were the same as those used by other groups&#44; with third-generation cephalosporins and aminoglycosides being the most widely used&#46; This is because most courses of antibiotherapy administered in the home were used in patients with CF&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">As for the type of vascular access used&#44; our data were consistent with most of the published literature<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> that establishes peripheral access as the first choice&#46; In case of complicated vascular access or in patients who are receiving frequent courses of antibiotics&#44; a peripherally inserted central catheter or a conventional central catheter are used&#44; although there is an increasing number of publications that propose the peripherally inserted central line as the first-choice route&#44; presenting it as a safer&#44; more effective&#44; and less costly option&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">In our study&#44; the rate of complications was 9&#46;8&#37;&#44; far lower than rates reported in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;17&#44;18</span></a> Consistent with the literature&#44; the most frequent complications were extravasation or accidental displacement of the peripheral line&#44; although the percentage was low in our sample&#44; probably because most of our patients are older than 5 years&#46; We did not register any other complications that&#44; while infrequent&#44; are reported in other studies&#44; like neutropenia or fever&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Our rate of episodes with favourable clinical outcome &#40;90&#46;2&#37;&#41; is very similar to what has been reported in the literature up to date&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;18</span></a> We should note that only 16 &#40;9&#46;8&#37;&#41; patients in our study required readmission&#44; and that 12 &#40;7&#46;4&#37;&#41; of them required it unexpectedly for reasons related to their underlying disease&#44; and not to therapeutic failure for the infection for which they were being treated&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Home administration of the prescribed treatment has several advantages&#46; The most obvious advantage for patients is that they remain in their environment&#44; and some can resume their school activities&#46; In addition&#44; evidence from various published studies show that this type of therapy increases the psychological wellbeing of paediatric patients&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> improves the physical&#44; social&#44; and emotional quality of life of adults&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> and results in a reduction in the number of nosocomial infections&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> The advantage over hospitalisation for providers is that they can treat patients in a pleasanter environment for latter&#44; improving provider&#8211;patient communication and rapport&#46; Lastly&#44; it is advantageous for the administration&#44; as it has been proven that OPAT results in fewer overnight stays at the hospital and lower costs for the hospital&#44;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;23</span></a> in addition to increasing patient satisfaction&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Although at-home OPAT administered by the carers has been established as a safe&#44; efficacious&#44; practical&#44; and cost-effective treatment option&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> and offers an alternative to patients who wish to return to their normal environment&#44; which was supported by the results of our study&#44; there are also disadvantages and risks&#46; Some of these include the decreased ability to monitor the patient properly at home&#44; the lower degree of supervision&#44; the feelings of insecurity of carers at the beginning of treatment&#44; and the medical complications that could arise in relation to the treatment&#46; Although these are inherent risks in OPAT&#44; our unit minimises them by the strict selection of patients and carers&#44; offering intensive&#44; problem-solving training during the hospital stay&#44; and providing a quick means of communication between carers and the team in charge through the phone&#46; Thus&#44; the essential factors for a successful OPAT programme are&#58; to have the appropriate infrastructure&#44; to make a careful selection of patients&#44; to have a multidisciplinary staff with experience both in at-home care delivery and in the diagnosis and treatment of infectious diseases&#44; to provide the necessary information and training&#44; and to properly monitor the patient who is receiving this type of treatment&#46; The hospital must guarantee continued care 24<span class="elsevierStyleHsp" style=""></span>h a day to address any complications that may arise&#44; and ideally there would be HHU coverage for most of these hours&#46; Also&#44; the HHU should work in close collaboration with the referring provider and with the infectious disease and pharmacy services&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">There are a growing number of review studies on the home administration of parenteral treatment in children with acute disease such as osteomyelitis&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> cellulitis&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> pneumonia&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> or pyelonephritis&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">Our study has the following limitations&#58; it is a single-centre study and the majority of referrals we receive are CF patients&#46; These limitations may have resulted in biases in our analysis&#44; which could be brought to light when comparing our results with those of other published studies&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">This review and analysis has allowed us to identify areas where we are lacking&#44; providing an incentive to try to design protocols based on scientific evidence and our clinical experience in the near future that would include not only patients with underlying chronic disease&#44; but also patients with acute disease that could receive parenteral antimicrobial treatment at home&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicts of interest</span><p id="par0230" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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          "identificador" => "xres360538"
          "titulo" => array:5 [
            0 => "Abstract"
            1 => "Objetives"
            2 => "Patients and methods"
            3 => "Results"
            4 => "Conclusions"
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        1 => array:2 [
          "identificador" => "xpalclavsec340401"
          "titulo" => "Keywords"
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          "titulo" => array:5 [
            0 => "Resumen"
            1 => "Objetivo"
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            3 => "Resultados"
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          "titulo" => "Palabras clave"
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          "titulo" => "Introduction"
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        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Patients and methods"
          "secciones" => array:9 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Study design"
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            1 => array:2 [
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              "titulo" => "Team in charge"
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              "identificador" => "sec0025"
              "titulo" => "Sources of patient referrals"
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              "identificador" => "sec0030"
              "titulo" => "Patients"
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              "identificador" => "sec0035"
              "titulo" => "Patient and carer training"
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              "identificador" => "sec0040"
              "titulo" => "Study variables"
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            6 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Antibiotic choice&#44; dosage&#44; and infusion system"
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              "identificador" => "sec0050"
              "titulo" => "Monitoring"
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              "titulo" => "Data analysis"
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          "identificador" => "sec0060"
          "titulo" => "Results"
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          "identificador" => "sec0065"
          "titulo" => "Discussion"
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          "identificador" => "sec0070"
          "titulo" => "Conflicts of interest"
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          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2013-03-30"
    "fechaAceptado" => "2013-05-14"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec340401"
          "palabras" => array:3 [
            0 => "Outpatient parenteral antimicrobial therapy"
            1 => "Home therapy"
            2 => "Paediatric infections"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec340400"
          "palabras" => array:5 [
            0 => "Tratamiento antimicrobiano domiciliario intravenoso"
            1 => "Tratamiento antimicrobiano parenteral ambulatorio"
            2 => "Tratamiento domiciliario"
            3 => "Intravenoso"
            4 => "Infecci&#243;n"
          ]
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      ]
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    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objetives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Parenteral antibiotic treatment has been classically developed in hospitals and is considered as a hospital procedure&#46; The development of Hospital at Home Units &#40;HHU&#41; has led to an increase in outpatient parenteral antibiotic therapy &#40;OPAT&#41; in paediatric patients&#46; The objective of this study is to describe our experience&#44; as an HHU integrated within a Paediatric Department&#44; in home antimicrobial therapy over a period of 12 years&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This prospective and descriptive study included every patient with a disease requiring parenteral antimicrobial therapy who was admitted to our HHU from January 2000 to December 2012&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">During the study there were 163 cases on OPAT&#46; The mean age of the patients was 11&#46;1 years&#44; and the sample group was comprised of 33 males and 22 females&#46; The main sources of the treated infections were respiratory tract &#40;76&#37;&#41;&#44; catheter-related bloodstream &#40;9&#46;2&#37;&#41;&#44; and urinary tract infections &#40;5&#46;5&#37;&#41;&#46; Amikacin was the most widely used antibiotic&#46; Almost all treatments &#40;96&#46;6&#37;&#41; were via an intravenous route&#46; Catheter-associated complications were more common than drug-associated complications&#46; Successful at-home treatment was observed in 90&#46;2&#37; of cases&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">OPAT is a good and safe alternative in many paediatric diseases&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cl&#225;sicamente la administraci&#243;n de tratamientos intravenosos se ha asociado a la necesidad de ingreso hospitalario&#46; A partir de la formaci&#243;n de unidades de hospitalizaci&#243;n a domicilio &#40;UHD&#41; se han extendido e incrementado el n&#250;mero de tratamientos antimicrobianos administrados por v&#237;a parenteral en pacientes pedi&#225;tricos en su domicilio&#46; El objetivo de este art&#237;culo es exponer la experiencia en tratamientos parenterales en domicilio en una UHD pedi&#225;trica durante un periodo de 12 a&#241;os&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se realiza un estudio descriptivo&#44; prospectivo&#46; Se incluyeron en el estudio a todos los pacientes atendidos en nuestra UHD por enfermedad subsidiaria de tratamiento parenteral desde enero de 2000 hasta diciembre de 2012&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se han instaurado 163 tratamientos parenterales en domicilio&#46; La edad media fue de 11&#44;1 a&#241;os&#46; Por sexos&#44; 40&#37; mujeres y 60&#37; varones&#46; Las infecciones tratadas han sido&#44; en su mayor&#237;a&#44; sobreinfecciones respiratorias &#40;76&#37;&#41;&#44; infecciones del cat&#233;ter central &#40;9&#44;2&#37;&#41; e infecciones del tracto urinario &#40;5&#44;5&#37;&#41;&#46; El antibi&#243;tico m&#225;s utilizado ha sido la amikacina&#46; El 96&#44;9&#37; de los tratamientos fue intravenoso&#46; La complicaci&#243;n m&#225;s frecuente ha sido la extravasaci&#243;n o p&#233;rdida de v&#237;a &#40;7&#44;4&#37;&#41;&#46; Se complet&#243; el tratamiento en domicilio en un 90&#44;2&#37; de los casos&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La administraci&#243;n de tratamientos parenterales en domicilio es una opci&#243;n asistencial buena y segura en pacientes pedi&#225;tricos&#46;</p>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as&#58; Pel&#225;ez Cantero MJ&#44; Madrid Rodr&#237;guez A&#44; Urda Cardona AL&#44; Jurado Ortiz A&#46; Tratamiento antimicrobiano parenteral domiciliario&#58; an&#225;lisis prospectivo de los &#250;ltimos 12 a&#241;os&#46; Anal Pediatr &#40;Barc&#41;&#46; 2014&#59;81&#58;86&#8211;91&#46;</p>"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Age distribution &#40;in bar diagram&#41; of patients who received OPAT&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Number of outpatient treatment episodes administered at home and number of the hospitalisation days per year&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">Inclusion criteria</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Medically stable patient&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Non-progressing infection&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Family support&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Carers are physically and mentally able to provide treatment in the home&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Home address within the HHU service area&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Having a telephone&#44; running water&#44; and refrigerator&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Voluntary consent for at-home treatment&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Signed informed consent&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infection can be treated orally&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Need for some other inpatient treatment&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">CMV&#58; cytomegalovirus&#59; CF&#58; cystic fibrosis&#59; VP shunt&#58; ventriculo-peritoneal shunt&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Types of episodes &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>163&#41;</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Respiratory tract superinfection in CF patient&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">124 cases&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1 cases&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Central catheter infection</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Genitourinary infection</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Soft-tissue infections &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">4&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Varicella&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Herpes zoster&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Celullitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Febrile neutropenia in oncology patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Digestive system infections &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">2&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cholangitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">CMV infection</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Bacteraemia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Fever without a source</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">VP shunt infection</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Types of episodes treated at home&#46;</p>"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">MRSA&#44; methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span>&#59; MSSA&#44; methicillin-sensitive <span class="elsevierStyleItalic">Staphylococcus aureus</span>&#46;</p>"
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Microbiology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">No&#46; of episodes &#40;&#37; of 163&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;25&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Polymicrobial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">MSSA</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">MRSA</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Pseudomonas</span> ssp&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Blood culture</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;9&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Gram-positive<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Gram-negative<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Other<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Urine culture</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;4&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Klebsiella oxytoca</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Proteus mirabilis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Candida parapsilosis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Unidentified</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99 &#40;60&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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Article information

ISSN: 23412879
Original language: English

DOI:10.1016/j.anpede.2013.05.001

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Year/Month	Html	Pdf	Total

2024 November	8	11	19
2024 October	30	38	68
2024 September	44	31	75
2024 August	56	66	122
2024 July	35	33	68
2024 June	48	38	86
2024 May	49	30	79
2024 April	36	32	68
2024 March	43	19	62
2024 February	45	29	74
2024 January	24	22	46
2023 December	39	14	53
2023 November	34	24	58
2023 October	36	20	56
2023 September	27	25	52
2023 August	30	16	46
2023 July	53	23	76
2023 June	46	21	67
2023 May	87	24	111
2023 April	26	16	42
2023 March	46	20	66
2023 February	27	20	47
2023 January	39	28	67
2022 December	68	26	94
2022 November	51	31	82
2022 October	42	56	98
2022 September	40	37	77
2022 August	40	43	83
2022 July	28	31	59
2022 June	31	40	71
2022 May	26	35	61
2022 April	39	36	75
2022 March	34	48	82
2022 February	34	31	65
2022 January	44	47	91
2021 December	28	44	72
2021 November	35	37	72
2021 October	44	57	101
2021 September	26	53	79
2021 August	44	38	82
2021 July	35	44	79
2021 June	28	33	61
2021 May	31	30	61
2021 April	97	45	142
2021 March	53	33	86
2021 February	25	12	37
2021 January	34	26	60
2020 December	35	25	60
2020 November	33	19	52
2020 October	34	17	51
2020 September	22	16	38
2020 August	37	9	46
2020 July	26	15	41
2020 June	38	11	49
2020 May	62	18	80
2020 April	48	18	66
2020 March	49	20	69
2020 February	50	16	66
2020 January	43	12	55
2019 December	44	24	68
2019 November	35	12	47
2019 October	32	13	45
2019 September	37	14	51
2019 August	69	22	91
2019 July	49	19	68
2019 June	40	22	62
2019 May	62	16	78
2019 April	54	33	87
2019 March	44	18	62
2019 February	41	14	55
2019 January	41	21	62
2018 December	50	29	79
2018 November	128	39	167
2018 October	155	23	178
2018 September	90	7	97
2018 August	1	0	1
2018 June	6	0	6
2018 May	8	0	8
2018 April	23	0	23
2018 March	26	0	26
2018 February	22	0	22
2018 January	197	0	197
2017 December	197	0	197
2017 November	44	0	44
2017 October	16	0	16
2017 September	14	1	15
2017 August	11	0	11
2017 July	10	0	10
2017 June	26	11	37
2017 May	16	4	20
2017 April	17	6	23
2017 March	15	2	17
2017 February	11	10	21
2017 January	6	6	12
2016 December	34	8	42
2016 November	43	4	47
2016 October	41	3	44
2016 September	34	4	38
2016 August	29	2	31
2016 July	14	4	18

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