Multidisciplinary Tool Kit for Febrile Neutropenia: Stewardship Guidelines,Staphylococcus aureusEpidemiology, and Antibiotic Use Ratios
| Autor: | Kelsie Cowman, Adam F. Binder, Wendy Szymczak, Yi Guo, Belinda Ostrowsky, Michael H. Levi, Priya Nori, Carol Sheridan, Rachel Bartash, Philip Gialanella |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Oncology (nursing) business.industry Health Policy medicine.disease medicine.disease_cause 03 medical and health sciences 0302 clinical medicine Oncology Staphylococcus aureus 030220 oncology & carcinogenesis Epidemiology medicine Vancomycin Antimicrobial stewardship 030212 general & internal medicine Stewardship Antibiotic use business Intensive care medicine Febrile neutropenia medicine.drug |
| Zdroj: | JCO Oncology Practice. 16:e563-e572 |
| ISSN: | 2688-1535 2688-1527 |
| DOI: | 10.1200/jop.19.00492 |
| Popis: | PURPOSE:Inappropriate vancomycin for febrile neutropenia (FN) is an ideal antimicrobial stewardship target. To improve vancomycin prescribing, we instituted a multifaceted intervention, including an educational guideline with audit for compliance; an antibiotic use audit; and an assessment of local burden of methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection.MATERIALS AND METHODS:We conducted a quasi-experimental pre-post intervention review of vancomycin initiation for FN on a 32-bed hematology/oncology unit. A retrospective chart review was conducted from November 2015 to May 2016 (preintervention period). In January 2017, we implemented an institutional FN guideline emphasizing criteria for appropriate use. Vancomycin audit was conducted from February 2017 to October 2017 (postintervention period). The primary outcome was appropriateness of vancomycin initiation. We then compared average antibiotic use (days of therapy per 1,000 patient days) for vancomycin and cefepime before and after intervention. Finally, unit-wide MRSA screening cultures were obtained upon admission and bimonthly for 6 weeks (October 2, 2017, to November 9, 2017). Screened patients were followed for 12 months for clinical MRSA infection.RESULTS:Forty-three (49%) of 88 preintervention patients were started on empiric vancomycin appropriately, compared with 59 (66%) of 90 postintervention patients ( P = .02). There was a significant decrease in vancomycin use after intervention. Six (7.1%) of 85 patients screened positive for MRSA colonization. During the 12-month follow-up, no colonized patients developed clinical MRSA infections (positive predictive value, 0.0%). Of the 79 noncolonized patients, 2 developed a clinically significant infection (negative predictive value, 97.5%).CONCLUSION:Guideline-focused education can improve vancomycin appropriateness in FN and should be bundled with education and feedback about local MRSA epidemiology and antibiotic use rates for maximal stewardship impact. |
| Databáze: | OpenAIRE |
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