Evaluation of the effectiveness, safety and costs of outpatient intravenous antimicrobial treatment (OPAT) vs hospitalized in urinary infection in Pediatrics

Background: Childrens hospitalization for intravenous antibiotic treatment has been replaced in developed countries and in some Chilean, centers to outpatient intravenous therapy ((RAT). Aim; To compare the effectiveness, safety and cost-of PAT versus inpatient care. Patients and Methods: Prospective cohort study in children (2 months-5 years) with febrile urinary tract infection (UTI) attended at two public Chilean hospitals: outpatient cohort and inpatient cohort. Between November of 2009-2010, 111 children were enrolled in OPAT and between January 2010-June 2011, 81 children were hospitalized. Demographic data, costs and parental care, response to treatment, adverse.eventS and Complications were registered. Results: There was no difference in the effectiveness of both treatments (100% in OPAT and 98.6% inpatient cohort, p: 0.41). Adherence to OPAT was 100%. Prevalence of adverse events was higher in inpatient cohort (76.3% versus 16.2%, p < 0.01). The average-direct cost Was four times higher in inpatients., mainly due to bed-day cost Indirect cost was,similar in both groups. There Were more days of absence front work and care,centers in inpatients (p: 0017, p: 0.045 respectively). Conclusion: OPAT for febrile UTI was equally effective, safer and significantly less expensive than inpatient care. OPAT represents a recommended intervention for pediatric services of Chilean public hospitals.