Impact of an alternating first-line antibiotics strategy in febrile neutropenia

Tan, Ban Hock; Guzman, Marvin Raden Torres De; Donato, Lara Kristina Sioco; Kalimuddin, Shirin; Lee, Winnie Hui Ling; Tan, Ai Ling; Wong, Gee Chuan

doi:10.1371/journal.pone.0208039

Cited by 5 publications

(4 citation statements)

References 20 publications

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“…Usually, patients are screened for MRSA (nose swabs) and VRE (rectal swabs) and carbapenem-resistant Enterobacterales (rectal swabs). Patients colonized/infected by the most dangerous resistant strains are isolated in single rooms depending on the availability of individual rooms in the facility [89]. Moreover, knowledge of the colonizing microorganism can be helpful in guiding the empirical antibiotic therapy [21].…”

Section: Prevention Of P Aeruginosa Infection In Cancer Patientsmentioning

confidence: 99%

Pseudomonas aeruginosa Infections in Cancer Patients

et al. 2022

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Pseudomonas aeruginosa (P. aeruginosa) is one of the most frequent opportunistic microorganisms causing infections in oncological patients, especially those with neutropenia. Through its ability to adapt to difficult environmental conditions and high intrinsic resistance to antibiotics, it successfully adapts and survives in the hospital environment, causing sporadic infections and outbreaks. It produces a variety of virulence factors that damage host cells, evade host immune responses, and permit colonization and infections of hospitalized patients, who usually develop blood stream, respiratory, urinary tract and skin infections. The wide intrinsic and the increasing acquired resistance of P. aeruginosa to antibiotics make the treatment of infections caused by this microorganism a growing challenge. Although novel antibiotics expand the arsenal of antipseudomonal drugs, they do not show activity against all strains, e.g., MBL (metalo-β-lactamase) producers. Moreover, resistance to novel antibiotics has already emerged. Consequently, preventive methods such as limiting the transmission of resistant strains, active surveillance screening for MDR (multidrug-resistant) strains colonization, microbiological diagnostics, antimicrobial stewardship and antibiotic prophylaxis are of particular importance in cancer patients. Unfortunately, surveillance screening in the case of P. aeruginosa is not highly effective, and a fluoroquinolone prophylaxis in the era of increasing resistance to antibiotics is controversial.

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Section: Prevention Of P Aeruginosa Infection In Cancer Patientsmentioning

confidence: 99%

Pseudomonas aeruginosa Infections in Cancer Patients

et al. 2022

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“…Moreover, our antibiotic consumption was high comparable with the consumption reported in the Meyer study in ICU (25) and the Tan study in two hematology wards before their intervention on the antibiotics' consumption. (26) This increase could have in uenced our ESBLE acquisition ID and could explain the higher trend (not signi cant) in post-intervention period. This increase might be explained too by the increase of ESBLE ID trend (not signi cant).…”

Section: Discussionmentioning

confidence: 90%

Effects of Discontinuing Contact Precaution on Control of Extended-Spectrum β-lactamase-producing Enterobacteriaceae Nosocomial Acquisition: An Interrupted Time Series Analysis

Regad

Renaudin

Lizon

et al. 2020

Preprint

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Background: Interest of contact precautions (CP) to prevent cross-transmission in addition to standard precautions (SP) is actually debated in the literature for some microorganisms, like extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBLE). We took advantage of the decision to stop CP for ESBLE in our hospital to study in real life if this discontinuing has an impact on the ESBLE acquisition rate. Methods: An interrupted time series (ITS) was performed in 3 wards and the week was used as the temporal unit. The ESBLE acquisition and importation incidence density (ID) and potential risks factors (colonization and selective pressure, Alcohol-Based hand rub solution consumption rates, demographic patients data) were collected between two periods: the pre-intervention (July 2018 to June 2019) when patients infected or colonized by ESBLE were cared with PC and SP and the post-intervention (September 2019 to March 2020) when patients were cared with SP only. Results: ESBLE acquisition ID were of 1.32 ± 1.36 and 1.17 ± 1.25 cases per 1000 patient-days for the pre- and post-intervention period respectively with no significant change in slope (p = 0.15). The only confounding variable significant (p = 0.04) in ITS was the antibiotics consumption, with a positive increasing trend. Conclusion: This study showed that the SP alone in order to control the ESBLE nosocomial did not lead to increasing the ESBLE nosocomial cross-transmission.

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“…On the contrary, in patients with persistent fever, non-resolving signs of infection, and rising PCT trends, we recommend intensifying the workup, broadening antibiotic cover, and optimizing the PKPD parameters of prescribed antibiotics. 79…”

Section: 1mentioning

confidence: 99%

“…In patients with clinical improvement, negative microbiological cultures, and reassuring PCT trends, we recommend narrowing antibiotic cover and shortening the duration of therapy. On the contrary, in patients with persistent fever, non‐resolving signs of infection, and rising PCT trends, we recommend intensifying the workup, broadening antibiotic cover, and optimizing the PKPD parameters of prescribed antibiotics 79 …”

Section: Strategies To Improve Antimicrobial Use In the Transplant Unitmentioning

confidence: 99%

Current state of antimicrobial stewardship in organ transplantation in Singapore

Chung

Liew

Lee

et al. 2022

Transplant Infectious Dis

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Background Antibiotic stewardship programs (ASPs) are well established in the public hospitals in Singapore, but they are not mandatory for transplant programs. Given the positive impact of ASPs in non‐organ transplant patients (improved use of broad‐spectrum antibiotics, reduced length of stay, and lower healthcare costs), stewardship principles are likely to benefit transplant recipients. Methods We reviewed the progress made in ASPs in the Asia Pacific region as well as the progress of our ASP over the last decade since it was established. We also described how stewardship strategies have evolved for the purposes of our transplant program. Results Currently, pressing stewardship issues for our transplant program include high antibiotic consumption, as well as the burden, morbidity, and mortality associated with drug‐resistant bacterial infections. Transplanting the model of stewardship onto a transplant program ignores the intricacies of transplant patients; the bespoke form of stewardship, “handshake stewardship”, is more appropriate. Conclusion To advance the cause of ASP in the transplant unit in Singapore, stakeholder buy‐in is key; empowering transplant physicians to be stewardship‐focused would be more sustainable in the long run. In addition, expanding our diagnostic armamentarium, optimizing existing therapeutics and multi‐disciplinary team involvement (including stakeholders from microbiology, and infection prevention teams) are vital.

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Impact of an alternating first-line antibiotics strategy in febrile neutropenia

Cited by 5 publications

References 20 publications

Pseudomonas aeruginosa Infections in Cancer Patients

Pseudomonas aeruginosa Infections in Cancer Patients

Effects of Discontinuing Contact Precaution on Control of Extended-Spectrum β-lactamase-producing Enterobacteriaceae Nosocomial Acquisition: An Interrupted Time Series Analysis

Current state of antimicrobial stewardship in organ transplantation in Singapore

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