Antibiotic use during infectious episodes in the first 6 months of anticancer treatment-A Swedish cohort study of children aged 7-16 years

Sandeberg, Margareta af; Johansson, Eva; Wettergren, Lena; Björk, Olle; Hertting, Olof; Nilsson, Anna

doi:10.1002/pbc.26397

Cited by 12 publications

(20 citation statements)

References 25 publications

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“…Due to the severity of the patientsʼ underlying disease and immunosuppression, high administration rates of antibiotics have been documented in pediatric cancer patients [6,10], including carbapenems [9]. The appropriateness of carbapenem use in pediatric cancer patients has been addressed by a few recent publications describing retrospective consumption data and antibiotic stewardship (ABS) initiatives [1,13,14,19,20]. These studies consistently depicted high baseline consumption, which may be interpreted as an indicator of meropenem overuse.…”

Section: Introductionmentioning

confidence: 99%

Meropenem Use in Pediatric Oncology – Audit on Indication, Appropriateness and Consumption Comparing Patient Derived and Pharmacy Dispensing Data

Ockfen

Egle

Sauter³

et al. 2021

Klin Padiatr

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Background Meropenem is an important second- or third-line antibiotic in pediatric cancer patients with febrile neutropenia (FN). Concise utilization data of meropenem in this setting is limited. It remains unclear how drug dispensing data from the hospital pharmacy correlate with data derived from patients’ files. Methods Retrospective audit of meropenem-consumption in a University-affiliated pediatric oncology center in days of therapy (DOT)/100 inpatient days. The individual indication for meropenem was critically reviewed. The real consumption (in g/100 inpatient days) was compared with the drug amounts dispensed by the hospital pharmacy (in gram and in defined daily doses (DDD)/100 inpatient days). All patients receiving at least one dose of meropenem from 1st of April 2016 until the 30th of June 2018 were included. Result Of 235 consecutive patients, 45 (19%) received meropenem, comprising 57 FN events. The probability of receiving at least one dose of meropenem was significantly higher in patients with ALL, AML, NHL and certain CNS tumors. Preceding the use of meropenem, only 5% of patients were known to be colonized with multidrug-resistant Gram-negative pathogens. Meropenem was administered as first-line treatment in 26% of all meropenem cycles, in 74% of all FN events with meropenem, Piperacillin-Tazobactam was used for initial treatment. In 5 of 57 FN events (8.8%), initial blood cultures yielded a Gram-negative pathogen. Concerning definite treatment, appropriate alternatives to meropenem with a smaller spectrum of activity would have been available in 4 cases, but a de-escalation was not performed. The median length of therapy in the meropenem group was 6 days, the corresponding median for days of therapy (DOT) was 12 days. This corresponds with combination therapy in 56% of all meropenem treatments, mostly with teicoplanin. On average, drug dispensing data from the hospital pharmacy were 1.53 times higher than real use (relying on patients’ data) without a significant correlation. A higher Case-mix Index positively correlated with meropenem-consumption. Conclusion The use of meropenem should become a target of antibiotic stewardship programs in order to restrict its use to certain indications and preserve its outstanding role as second- or third-line antibiotic in this vulnerable population. Irrespective of the metrics used (g or DDD/100 inpatient days), pharmacy dispensing data do not accurately depict real patient-derived data concerning meropenem use in pediatric cancer patients.

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Section: Introductionmentioning

confidence: 99%

Meropenem Use in Pediatric Oncology – Audit on Indication, Appropriateness and Consumption Comparing Patient Derived and Pharmacy Dispensing Data

Ockfen

Egle

Sauter³

et al. 2021

Klin Padiatr

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“…Fever during neutropenia may be the only sign of an infectious episode, but in the majority of pediatric cancer patients with fever during neutropenia, the focus of the underlying infection remains unclear and cannot be documented microbiologically (e.g., bloodstream infection with a pathogen isolated) or clinically (e.g., pneumonia). Because of the risk of a complicated clinical course and the spectrum of pathogens causing severe and life-threatening bacterial infections in pediatric cancer patients, timely inpatient treatment with broad-spectrum antibiotics is the standard of care [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

Management of children with fever and neutropenia: results of a survey in 51 pediatric cancer centers in Germany, Austria, and Switzerland

et al. 2020

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Purpose Investigation of the current practice of diagnostics and treatment in pediatric cancer patients with febrile neutropenia. Methods On behalf of the German Society for Pediatric Oncology and Hematology and the German Society for Pediatric Infectious Diseases, an Internet-based survey was conducted in 2016 concerning the management of febrile neutropenia in pediatric oncology centers (POC). This survey accompanied the release of the corresponding German guideline to document current practice before its implementation in clinical practice. Results In total, 51 POCs participated (response rate 73%; 43 from Germany, and 4 each from Austria and Switzerland). Identified targets for antimicrobial stewardship concerned blood culture diagnostics, documentation of the time to antibiotics, the use of empirical combination therapy, drug monitoring of aminoglycosides, the time to escalation in patients with persisting fever, minimal duration of IV treatment, sequential oral treatment in patients with persisting neutropenia, indication for and choice of empirical antifungal treatment, and the local availability of a pediatric infectious diseases consultation service. Conclusion This survey provides useful information for local antibiotic stewardship teams to improve the current practice referring to the corresponding national and international guidelines. Electronic supplementary material The online version of this article (10.1007/s15010-020-01462-z) contains supplementary material, which is available to authorized users.

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“…In a high percentage of cases of neutropenic fever in ALL it is not possible to determine the focus of the underlying infection by documenting it clinically (e.g., pulmonary infiltration) or microbiologically (positive blood culture) within the first hours or days of fever onset. The standard of care is still the timely start with broad-spectrum antibiotics ( 42 , 48 ). Although several studies have improved algorithms regarding initiation, modification, and termination of antimicrobial treatment strategies, how to empirically treat the assumed pathogen remains the subject of controversy ( 43 , 49 ).…”

Section: Supportive Care In Conventional Childhood All Therapymentioning

confidence: 99%

Supportive methods for childhood acute lymphoblastic leukemia then and now: A compilation for clinical practice

et al. 2022

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Survival of childhood acute lymphoblastic leukemia has significantly improved over the past decades. In the early years of chemotherapeutic development, improvement in survival rates could be attained only by increasing the cytostatic dose, also by modulation of the frequency and combination of chemotherapeutic agents associated with severe short- and long-time side-effects and toxicity in a developing child's organism. Years later, new treatment options have yielded promising results through targeted immune and molecular drugs, especially in relapsed and refractory leukemia, and are continuously added to conventional therapy or even replace first-line treatment. Compared to conventional strategies, these new therapies have different side-effects, requiring special supportive measures. Supportive treatment includes the prevention of serious acute and sometimes life-threatening events as well as managing therapy-related long-term side-effects and preemptive treatment of complications and is thus mandatory for successful oncological therapy. Inadequate supportive therapy is still one of the main causes of treatment failure, mortality, poor quality of life, and unsatisfactory long-term outcome in children with acute lymphoblastic leukemia. But nowadays it is a challenge to find a way through the flood of supportive recommendations and guidelines that are available in the literature. Furthermore, the development of new therapies for childhood leukemia has changed the range of supportive methods and must be observed in addition to conventional recommendations. This review aims to provide a clear and recent compilation of the most important supportive methods in the field of childhood leukemia, based on conventional regimes as well as the most promising new therapeutic approaches to date.

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Antibiotic use during infectious episodes in the first 6 months of anticancer treatment-A Swedish cohort study of children aged 7-16 years

Cited by 12 publications

References 25 publications

Meropenem Use in Pediatric Oncology – Audit on Indication, Appropriateness and Consumption Comparing Patient Derived and Pharmacy Dispensing Data

Meropenem Use in Pediatric Oncology – Audit on Indication, Appropriateness and Consumption Comparing Patient Derived and Pharmacy Dispensing Data

Management of children with fever and neutropenia: results of a survey in 51 pediatric cancer centers in Germany, Austria, and Switzerland

Supportive methods for childhood acute lymphoblastic leukemia then and now: A compilation for clinical practice

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