Individualized Antibiotic Plans as a Quality Improvement Initiative to Reduce Carbapenem Use for Hematopoietic Cell Transplant Patients at a Freestanding Pediatric Hospital.

Autor:	Brothers AW; Department of Pharmacy, Seattle Children's Hospital, Seattle, Washington, USA., Pak DJ; Department of Pharmacy, Seattle Children's Hospital, Seattle, Washington, USA., Poole NM; Departments of Pediatrics, Section of Pediatric Infectious Diseases, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA., Kronman MP; Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Washington, Seattle, Washington, USA., Bettinger B; Department of Clinical Analytics, Seattle Children's Hospital, Seattle, Washington, USA., Wilkes JJ; Department of Pediatrics, Division of Hematology/Oncology, University of Washington, Seattle, Washington, USA.; Ben Towne Center for Childhood Cancer Research, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA., Carpenter PA; Division of Clinical Research, Fred Hutchinson Cancer Center, Seattle, Washington, USA.; Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA., Englund JA; Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Washington, Seattle, Washington, USA., Weissman SJ; Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Washington, Seattle, Washington, USA.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2024 Jan 25; Vol. 78 (1), pp. 15-23.
DOI:	10.1093/cid/ciad518
Abstrakt:	Background: Providers must balance effective empiric therapy against toxicity risks and collateral damage when selecting antibiotic therapy for patients receiving hematopoietic cell transplant (HCT). Antimicrobial stewardship interventions during HCT are often challenging due to concern for undertreating potential infections. Methods: In an effort to decrease unnecessary carbapenem exposure for patients undergoing HCT at our pediatric center, we implemented individualized antibiotic plans (IAPs) to provide recommendations for preengraftment neutropenia prophylaxis, empiric treatment of febrile neutropenia, and empiric treatment for hemodynamic instability. We compared monthly antibiotic days of therapy (DOT) adjusted per 1000 patient-days for carbapenems, antipseudomonal cephalosporins, and all antibiotics during two 3-year periods immediately before and after the implementation of IAPs to measure the impact of IAP on prescribing behavior. Bloodstream infection (BSIs) and Clostridioides difficile (CD) positivity test rates were also compared between cohorts. Last, providers were surveyed to assess their experience of using IAPs in antibiotic decision making. Results: Overall antibiotic use decreased after the implementation of IAPs (monthly reduction of 19.6 DOT/1000 patient-days; P = .004), with carbapenems showing a continuing decline after IAP implementation. BSI and CD positivity rates were unchanged. More than 90% of providers found IAPs to be either extremely or very valuable for their practice. Conclusions: Implementation of IAPs in this high-risk HCT population led to reduction in overall antibiotic use without increase in rate of BSI or CD test positivity. The program was well received by providers. Competing Interests: Potential conflicts of interest. J. J. W. reports a leadership or fiduciary role on the American Society of Pediatric Hematology/Oncology Practice Committee. J. A. E. reports research payments to institution from Pfizer, GlaxoSmithKline, AstraZeneca, and Merck; and consulting fees to author from AbbVie, AstraZeneca, Meissa Vaccines, Moderna, Pfizer, and Sanofi Pasteur. M. P. K. reports a role as board member of the Pediatric Infectious Diseases Society and 1 night of stay covered for attendance at a board meeting at the national IDWeek conference; and the following grants or contracts: Agency for Healthcare Research and Quality (AHRQ) grant number 1R01 HS027428-01 (principal investigator [PI]: J. Gerber; the goal of this project is to develop, locally adapt, and implement an antibiotic stewardship intervention at hospital discharge and measure the impact of this intervention on optimal antibiotic use and postdischarge adverse effects, unrelated to the present work) and National Institutes of Health grant number 1R01 NS101029-01A1 (PI: T. Simon; the goal of this project is to evaluate the cost-effectiveness of intrathecal antibiotics vs antibiotic-impregnated ventricular catheters for prevention of ventricular shunt infections, unrelated to the present work). S. J. W. reports a subcontract from Washington University to institution for a multicenter study funded by AHRQ to study antimicrobial stewardship in surgical antimicrobial prophylaxis; consulting fees and equity as stock in the privately held company Tend Health for serving as a scientific advisor; payment from Jane Clark, attorney, for expert testimony as a medicolegal consultant on a case of pediatric infection; funding for faculty travel to professional meetings from Seattle Children's Hospital; and patent holder on device to encapsulate stool specimens for fecal microbiota transplant with Tend Health. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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