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Implementation of an antimicrobial stewardship program for patients with febrile neutropenia

Published:November 21, 2017DOI:https://doi.org/10.1016/j.ajic.2017.09.030

      Background

      We aimed to describe the effectiveness of our standardized protocol for febrile neutropenia (FN), which was targeted to minimize unintended outcomes and reduce antimicrobial consumption.

      Methods

      The study was performed in a private hospital with 300 beds. We included all adult hematologic and oncologic cancer inpatients admitted between January 1, 2015-December 31, 2015, and January 1, 2016-May 31, 2017. The outcomes of the study were fatality, infections, and adherence to the antimicrobial stewardship program (ASP).

      Results

      We included 152 FN attacks of 95 adult inpatients from hematology and oncology wards; of these, 43% were women, and the median age was 57 years. The case fatality rate was 30% in the pre-ASP period and decreased to 11% in the post-ASP period (P = .024). The appropriate adding or changing (P = .006) and appropriate continuation or de-escalation or discontinuation of antimicrobials improved (P < .001). In the post-ASP period, Staphylococcus spp infections (from 22% to 8%, P = .02) and gram-negative infections decreased (from 43% to 20%, P = .003). In the multivariate analysis, appropriate continuation or de-escalation or discontinuation was increased in the post-ASP period (odds ratio [OR], 4.3; 95% confidence interval [CI], 1.82-10.41; P = .001), and gram-positive infections were decreased (OR, 0.32; 95% CI, 0.11-0.95, P = .041). Vancomycin and fluoroquinolone use decreased significantly.

      Conclusions

      After implementation of the ASP, the case fatality rate among the patients with FN decreased. Appropriate antimicrobial use increased and overall antimicrobial consumption was reduced. Bacterial infections and Candida infections decreased.

      Key Words

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      References

        • Klastersky J.
        Management of fever in neutropenic patients with different risks of complications.
        Clin Infect Dis. 2004; 39: S32-S37
        • Kuderer N.M.
        • Dale D.C.
        • Crawford J.
        • Cosler L.E.
        • Lyman G.H.
        Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients.
        Cancer. 2006; 106: 2258-2266
        • Infectious Diseases Society of America
        The 10 × '20 initiative: pursuing a global commitment to develop 10 new antibacterial drugs by 2020.
        Clin Infect Dis. 2010; 50: 1081-1083
        • Akova M.
        Antimicrobial stewardship in hematology patients.
        in: Pulcini C. Ergonul O. Can F. Beovic B. Antimicrobial stewardship. Elsevier, London (United Kingdom)2017: 205-217
        • Ramphal R.
        Changes in the etiology of bacteremia in febrile neutropenic patients and the susceptibilities of the currently isolated pathogens.
        Clin Infect Dis. 2004; 39: S25-S31
        • Ergonul O.
        • Aydin M.
        • Azap A.
        • Basaran S.
        • Tekin S.
        • Kaya S.
        • et al.
        Healthcare-associated gram-negative bloodstream infections: antibiotic resistance and predictors of mortality.
        J Hosp Infect. 2016; 94: 381-385
        • Ruhnke M.
        • Arnold R.
        • Gastmeier P.
        Infection control issues in patients with haematological malignancies in the era of multidrug-resistant bacteria.
        Lancet Oncol. 2014; 15: e606-e619
        • Freifeld A.G.
        • Bow E.J.
        • Sepkowitz K.A.
        • Boeckh M.J.
        • Ito J.I.
        • Mullen C.A.
        • et al.
        Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America.
        Clin Infect Dis. 2011; 52: e56-e93
        • Baden L.R.
        • Bensinger W.
        • Angarone M.
        • Casper C.
        • Dubberke E.R.
        • Freifeld A.G.
        • et al.
        National Comprehensive Cancer Network. Prevention and treatment of cancer-related infections.
        J Natl Compr Canc Netw. 2012; 10: 1412-1445
        • Rosa R.G.
        • Goldani L.Z.
        • dos Santos R.P.
        Association between adherence to an antimicrobial stewardship program and mortality among hospitalised cancer patients with febrile neutropaenia: a prospective cohort study.
        BMC Infect Dis. 2014; 14: 286
        • Schuts E.C.
        • Hulscher M.
        • Mouton J.W.
        • Verduin C.M.
        • Stuart J.
        • Overdiek H.
        • et al.
        Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis.
        Lancet Infect Dis. 2016; 16: 847-856
        • Ullmann A.J.
        • Akova M.
        • Herbrecht R.
        • Viscoli C.
        • Arendrup M.C.
        • Arikan-Akdagli S.
        • et al.
        ESCMID* guideline for the diagnosis and management of candida diseases 2012: adults with haematological malignancies and after haematopoietic stem cell transplantation (HCT).
        Clin Microbiol Infect. 2012; 18: 53-67
        • Cattaneo C.
        • Quaresmini G.
        • Casari S.
        • Capucci M.A.
        • Micheletti M.
        • Borlenghi E.
        • et al.
        Recent changes in bacterial epidemiology and the emergence of fluoroquinolone-resistant Escherichia coli among patients with haematological malignancies: results of a prospective study on 823 patients at a single institution.
        J Antimicrob Chemother. 2008; 61: 721-728
        • Gyssens I.C.
        • Kern W.V.
        • Livermore D.M.
        • ECIL-4, a joint venture of EBMT, EORTC, ICHS and ESGICH of ESCMID
        The role of antibiotic stewardship in limiting antibacterial resistance among hematology patients.
        Haematologica. 2013; 98: 1821-1825
        • Ergonul O.
        • Can F.
        • Akova M.
        Antimicrobial stewardship in Turkey.
        in: Pulcini C. Ergonul O. Can F. Beovic B. Antimicrobial stewardship. Elsevier, London (United Kingdom)2017: 331-333