Reductions in vancomycin and meropenem following the implementation of a febrile neutropenia management algorithm in hospitalized adults: An interrupted time series analysis
| Autor: | Catherine DeVoe, Tina M Gu, Brian Allan C Macapinlac, Alexandra Hilts-Horeczko, Scott R Hampton, Rosa Rodriguez-Monguio, Katherine Yang, Sarah B Doernberg, Rebecca L. Olin, Trang D Trinh, Lloyd E. Damon, Luke Strnad, Laura M Griffith, Lusha Wang, John H Dzundza, Larissa R. Graff, Samantha Shenoy |
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| Rok vydání: | 2021 |
| Předmět: |
Microbiology (medical)
Adult Pediatrics medicine.medical_specialty medicine.drug_class Epidemiology Population Antibiotics Clinical Trials and Supportive Activities Meropenem Medical and Health Sciences law.invention Interrupted Time Series Analysis 7.3 Management and decision making 03 medical and health sciences 0302 clinical medicine law Vancomycin Clinical Research medicine Humans 030212 general & internal medicine education Febrile Neutropenia 0303 health sciences education.field_of_study 030306 microbiology business.industry Clostridioides difficile Hematology medicine.disease Intensive care unit Management algorithm Emerging Infectious Diseases Infectious Diseases Good Health and Well Being Original Article Patient Safety Management of diseases and conditions business Infection Febrile neutropenia Algorithms medicine.drug |
| Zdroj: | Infection control and hospital epidemiology, vol 42, iss 9 Infection Control and Hospital Epidemiology |
| ISSN: | 0899-823X |
| Popis: | Objective:To evaluate broad-spectrum intravenous antibiotic use before and after the implementation of a revised febrile neutropenia management algorithm in a population of adults with hematologic malignancies.Design:Quasi-experimental study.Setting and population:Patients admitted between 2014 and 2018 to the Adult Malignant Hematology service of an acute-care hospital in the United States.Methods:Aggregate data for adult malignant hematology service were obtained for population-level antibiotic use: days of therapy (DOT), C. difficile infections, bacterial bloodstream infections, intensive care unit (ICU) length of stay, and in-hospital mortality. All rates are reported per 1,000 patient days before the implementation of an febrile neutropenia management algorithm (July 2014–May 2016) and after the intervention (June 2016–December 2018). These data were compared using interrupted time series analysis.Results:In total, 2,014 patients comprised 6,788 encounters and 89,612 patient days during the study period. Broad-spectrum intravenous (IV) antibiotic use decreased by 5.7% with immediate reductions in meropenem and vancomycin use by 22 (P = .02) and 15 (P = .001) DOT per 1,000 patient days, respectively. Bacterial bloodstream infection rates significantly increased following algorithm implementation. No differences were observed in the use of other antibiotics or safety outcomes including C. difficile infection, ICU length of stay, and in-hospital mortality.Conclusions:Reductions in vancomycin and meropenem were observed following the implementation of a more stringent febrile neutropenia management algorithm, without evidence of adverse outcomes. Successful implementation occurred through a collaborative effort and continues to be a core reinforcement strategy at our institution. Future studies evaluating patient-level data may identify further stewardship opportunities in this population. |
| Databáze: | OpenAIRE |
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