Implementation of an antimicrobial stewardship program for patients with febrile neutropenia

Madran, Bahar; Keske, Şiran; Tokça, Gizem; Dönmez, Ebru; Ferhanoğlu, Burhan; Çetiner, Mustafa; Mandel, Nil Molınas; Ergönül, Önder

doi:10.1016/j.ajic.2017.09.030

Cited by 17 publications

(25 citation statements)

References 13 publications

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“…4 The majority of the published literature focuses on guideline development for FN or sepsis management in cancer patients. Four studies focused on the impact of FN guideline implementation on antimicrobial use, [19][20][21][22] and 2 studies examined the impact on mortality (Table 2). 23,24…”

Section: Guidelines and Clinical Pathways For Empirical Treatmentmentioning

confidence: 99%

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Inpatient Antibiotic Stewardship Interventions in the Adult Oncology and Hematopoietic Stem Cell Transplant Population: A Review of the Literature

et al. 2019

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Objective: To review the use of antibiotic stewardship interventions in the adult oncology and hematopoietic cell transplantation (HCT) populations. Data Sources: A literature search of PubMed was performed from inception to October 31, 2019. The general search terms used were oncology, cancer, hematologic malignancy, antimicrobial stewardship, antibiotic stewardship, febrile neutropenia, neutropenic fever, de-escalation, discontinuation, prophylaxis, practice guidelines, clinical pathway, rapid diagnostics, Filmarray, Verigene, MALDI-TOF, antibiotic allergy, and antimicrobial resistance. Study Selection and Data Extraction: Relevant English-language studies describing interventions supported by the Infectious Diseases Society of America guidelines on “Implementing an Antibiotic Stewardship Program” were included. Data Synthesis: Antibiotic stewardship publications in the oncology population have increased in recent years. Studies have described the impact of stewardship interventions, including preauthorization, prospective audit and feedback, implementation of clinical pathways, de-escalation of empirical antibiotics for febrile neutropenia (FN) prior to neutrophil recovery, allergy assessments, and use of rapid diagnostic testing. Many of these interventions have been shown to decrease antibiotic use without increased negative consequences, such as affecting length of stay or mortality. Relevance to Patient Care and Clinical Practice: This review synthesizes available evidence for implementing antibiotic stewardship interventions, particularly de-escalation of antibiotics for FN and implementation of clinical pathways for FN and sepsis, in oncology patients and HCT recipients. Summary tables highlight studies and specific research needs for clinicians. Conclusions: Immunocompromised populations, including oncology patients, have often been excluded from stewardship studies. Antibiotic stewardship is effective in reducing antibiotic consumption and improving outcomes in this patient population, although more quality data are needed.

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Section: Guidelines and Clinical Pathways For Empirical Treatmentmentioning

confidence: 99%

“…Madran et al 19 reported their experience with a clinical pathway for FN management implemented by a newly formed multidisciplinary ASP. A total of 152 episodes of FN from oncology patients were analyzed, with 81 pre-implementation and 71 post-implementation.…”

Section: Treatment Of Febrile Neutropeniamentioning

confidence: 99%

Inpatient Antibiotic Stewardship Interventions in the Adult Oncology and Hematopoietic Stem Cell Transplant Population: A Review of the Literature

et al. 2019

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“…Despite the differences in study design, population and antimicrobial utilization due to different local treatment protocols and colonization rates by MDR bacteria, preceding results, similar to ours, illustrated the potential benefits of antimicrobial stewardship approaches. The adherence to ASP recommendation has demonstrated to be an effective and safe strategy with a 64% relative risk reduction in 28-day mortality [19] and a significant decrease in the fatality rate (from 30% to 11%) [5] both in patients with febrile neutropenia and hematological or solid tumors. In patients with hematological diseases and HSCT recipients, stopping antimicrobial therapy early did not significantly increase the incidence of fever relapse and positive blood cultures or the mortality rate, with the advantage of the reduction in the use of antibiotics [20][21][22].…”

Section: Discussionmentioning

confidence: 99%

“…In hematological patients receiving immunosuppressive therapy, collateral damages of antimicrobial consumption, especially broad-spectrum antibiotic therapy, include the selection of multidrug-resistant (MDR) microorganisms [2], an increased propensity to fungal infections [3], and microbiota dysbiosis [4]. Although, due to these reasons the impact of ASPs in patients with hematological diseases might be especially relevant, information regarding the development of antimicrobial stewardship strategies in these patients is scarce [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Impact of an Educational Antimicrobial Stewardship Program on Management of Patients with Hematological Diseases

et al. 2021

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Antimicrobial stewardship programs (ASPs) in hematological patients are especially relevant. However, information about ASPs in this population is scarce. For 11 years, we quarterly assessed antimicrobial consumption and incidence and death rates of multidrug-resistant (MDR) bloodstream infections (BSI) in the hematology Department. Healthcare activity indicators were also monitored yearly. We performed an interrupted time-series analysis. Antimicrobials showed a sustained reduction with a relative effect of −62.3% (95% CI −84.5 to −40.1) nine years after the inception of the ASP, being especially relevant for antifungals (relative effect −80.4%, −90.9 to −69.9), quinolones (relative effect −85.0%, −102.0 to −68.1), and carbapenems (relative effect −68.8%, −126.0 to −10.6). Incidence density of MDR BSI remained low and stable (mean 1.10 vs. 0.82 episodes per 1000 occupied bed days for the pre-intervention and the ASP period, respectively) with a quarterly percentage of change of −0.3% (95% CI −2.0 to 1.4). Early and late mortality of MDR BSI presented a steady trend (quarterly percentage of change −0.7%, 95% CI −1.7 to 0.3 and −0.6%, 95% CI −1.5 to 0.3, respectively). Volume and complexity of healthcare activity increased over the years. The ASP effectively achieved long-term reductions in antimicrobial consumption and improvements in the prescription profile, without increasing the mortality of MDR BSI.

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“…Prescriptions including at least one antibiotic were decreased, while antiviral use was increased and adherence to clinical pathway was increased in the post-ASP period when compared with pre-ASP period ( Table 2). The clinical pathway specific for the patients with febrile neutropenia was shown to decrease inappropriate antimicrobial use (Madran et al, 2018). In a recent study conducted in a tertiary university hospital in France, several ASPs including local treatment guidelines were implemented in ED and unnecessary antimicrobial prescriptions were decreased after implementation of these ASPs (Dinh et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of clinical pathway for upper respiratory tract infections in emergency department

Madran

Keske

Uzun

et al. 2019

International Journal of Infectious Diseases

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Objective: We aimed to demonstrate the benefits of implementing a clinical pathway to decrease the inappropriate use of antibiotics in upper respiratory tract infections (URTI) in an emergency department (ED). Methods: The study was performed in a hospital with 300 beds. All patients who applied with URTI from 1st to 30th of April 2017 were included and the appropriateness of the antibiotics were compared with the patients in the same period in 2016. A checklist for the clinical pathway of URTI was completed by the ED physicians. Results: 351 patients were included, 176 these patients were in pre-ASP period and 175 patients were in post-ASP period. The rate of prescriptions including antibiotics was 49% in pre-ASP period and has decreased to 29% in post-ASP period (p < 0.001). Adherence to clinical pathway has increased from 50% to 80% (p < 0.001). In the post-ASP period, clinical pathway was used in 133 out of 175 patients (76%) and the consequently rate of appropriate antibiotic use was 82%. Conclusion: The implementation of clinical pathway for URTI has decreased inappropriate antibiotic use in ED. As the secondary effect, using clinical pathway in ED also has increased the awareness of ED physicians who did not adhere to clinical pathway.

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Implementation of an antimicrobial stewardship program for patients with febrile neutropenia

Cited by 17 publications

References 13 publications

Inpatient Antibiotic Stewardship Interventions in the Adult Oncology and Hematopoietic Stem Cell Transplant Population: A Review of the Literature

Inpatient Antibiotic Stewardship Interventions in the Adult Oncology and Hematopoietic Stem Cell Transplant Population: A Review of the Literature

Long-Term Impact of an Educational Antimicrobial Stewardship Program on Management of Patients with Hematological Diseases

Effectiveness of clinical pathway for upper respiratory tract infections in emergency department

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