Out of hospital treatment of patients with melioidosis using ceftazidime in 24 h elastomeric infusors, via peripherally inserted central catheters


Sarah Huffam and Paulene Kittler, Infectious Diseases Unit, Royal Darwin Hospital, C/o AIDS/STD Unit, PO Box 40596, Casuarina NT 0810, Australia. Tel.: +61 8 89228888; Fax: +61 8 8922809; E-mail: sarah.huffam@nt.gov.au, paulene.kittler@nt.gov.au
Susan P. Jacups and Bart J. Currie (corresponding author), Menzies School of Health Research Charles Darwin University, and Northern Territory Clinical School Flinders University, PO Box 41096, Casuarina 0811, Australia. Tel.: +61 8 89228056; Fax: +61 8 89275187; E-mail: susanj@menzies.edu.au, bart@menzies.edu.au


Background  In the tropical north of the Northern Territory, Australia, 25–50 patients are admitted to Royal Darwin Hospital (RDH) each year with Burkholderia pseudomallei infection, or melioidosis. Treatment consists of initial intensive therapy with 2–4 weeks of intravenous antibiotics. Clinical improvement may occur early and patients often prefer to be managed out of hospital in the Hospital in the Home (HITH).

Objectives  To evaluate safety and efficacy of HITH management of patients with melioidosis.

Methods  A prospective observational study of our standard management which consists of 24 h infusions of ceftazidime infused through a peripherally inserted central catheter (PICC) line, plus oral sulphamethoxazole trimethoprim. Treatment is administered in the home, which may be in Darwin, regional areas or remote communities, or in a self-care unit located in the hospital grounds.

Results  From February 1998 to December 2001 150 patients were admitted to RDH with culture confirmed B. pseudomallei infection. Of these, 73 patients were treated with 24 h infusions of ceftazidime, of which 70 patients were managed by HITH. Complications of treatment include a PICC line complication rate of 10.6/1000 days in situ. Nine patients had relapse or recrudescence of disease, nearly all as a result of poor adherence to subsequent oral eradication therapy, these patients were all re-treated successfully. One patient remains infected with B. pseudomallei.

Conclusion  This clinical outcome study suggests that out of hospital management of melioidosis with 24 h infusions of ceftazidime via a PICC line is safe and effective.