Treating Endocarditis and other Serious infections at home Children and Adolescents

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Treating Endocarditis and other Serious
infections at home Children and Adolescents

• Mark Loewenthal, Pauline Dobson, Out About
  Team,
• John Hunter and John Hunter Childrens Hospital

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Typical treatment of Endocarditis

• PICC inserted
• Most children have general anaesthetic
• Some able to have PICC inserted by nurse PICC
  inserters on IVI team in paediatric ward

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Antibiotic Choice

• Textbook choice not compromised by
  convenience
• Continuous infusions of
• Benzylpenicillin
• Flucloxacillin
• Cefotaxime
• Vancomycin
• Intermittant bolus/slow push
• Aminoglycosides
• Ceftriaxone

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Referred by Paediatric Team

• Assessed by Out About team
• Education provided in person
• Given written material

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At home

• Continuous infusion usually administered by
  elastomeric device
• Changed daily

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Elastomeric device and PICC
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Care at home

• Device change and bolus administration
• Daily visit by community nurse or
• Parent trained by Out About team
• 24-hr on call
• Nursing
• Medical

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Carer for line
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Care at home

• Device change and bolus administration
• Daily visit by community nurse or
• Parent /Patient trained by Out About team
• 24-hr on call
• Nursing
• Medical
• Emergency department not used

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Conditions treated Paediatric HITH
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Home treatment of endocarditis

• 187 patients
• 6 Children all successful
• 1 relapse on 93 with complete follow-up
• adult with Enterococcus

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Vascular Devices
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Age excluding Cystic Fibrosis
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Age - CF
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Are lines safe at home?
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Summary

• Most children needing prolonged IV antibiotics
  can receive the majority of their therapy at home
• Parents and children benefit from participation
  in their own care
• The outcomes are at least as good as in hospital
• Team work is the key to success

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Outcomes long term follow up

• 69 of 73 patients followed up had successful
  outcomes
• Children had the same re-admission rates as
  adults
• No blood stream infections
• Longer time to first call out or phone call

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Questions?