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Introduction: Infections are one of the most common complications of anti-cancer therapy and cancer patients rely on effective antibiotics to prevent and treat infections. 41% of UK oncologists saw a rise in drug-resistant infections in 2019 and 46% believe drug-resistant infections could make chemotherapy unviable.1 Antibiotic exposure to bacteria and overuse of antibiotics contribute to antibiotic resistance.2 The UK 5-year action plan for tackling antimicrobial resistance 2019–2024 has set the target to reduce antibiotic use by 15% by 2024.2 Objectives 1. To reduce antibiotic use (defined daily doses (DDD) per 1000 total admissions (inc. Day Cases)) in a cancer centre by 15% by 2024. 2. To identify interventions that reduce antibiotic use (DDD per 1000 total admissions (inc. Day Cases)) in cancer patients. 3. To gather data on antibiotic use (DDD per 1000 total admissions (inc. Day Cases)) in 2018 in a cancer centre to establish a baseline. Method: Retrospective antibiotic use data from April 2018 to March 2019 was collected from DEFINE RX Info and plotted on a statistical process control (SPC) chart to establish a baseline. Interventions to reduce antibiotic use were identified by the project stakeholders and implemented through six plan, do, study and act (PDSA) cycles. Antibiotic use data was collected from DEFINE RX Info monthly from April 2019 to March 2021 and plotted on an SPC chart to establish the impact of interventions. Discussion: Figure 1 shows antibiotic use decreased by 1% in 2019/20 and by 12% in 2020/21. Overall antibiotic consumption decreased by 13% from the 2018/19 baseline. The SPC chart shows a special cause improvement demonstrating a statistically significant reduction in antibiotic prescribing. The frequency of auditing adherence to the Start Smart – then Focus principles was increased from 6 monthly to once monthly during PDSA 1 and from once monthly to twice weekly during PDSA 4. These interventions enabled the poor prescribing practice to be promptly identified and education and training were provided to prescribers in real time to improve antibiotic stewardship. Ciprofloxacin neutropenic sepsis prophylaxis was removed from solid tumour anti-cancer therapy proformas in response to the MHRA Fluoroquinolone Drug Safety Alert in PDSA 2. Ciprofloxacin consumption decreased by 35% between 2018/19 and 2020/21 and unintentional negative patient impact has not been observed. The Antimicrobial Guidelines were moved from a large PDF document to a digital mobile application in PDSA 3. This enables quick and easy access to antibiotic guidance and course length to improve antibiotic stewardship. Twice weekly face-to-face antimicrobial stewardship ward rounds moved to video call in PDSA 5. This enabled ward rounds to continue throughout the Covid-19 pandemic. An additional benefit was it was easier to access patients’ electronic healthcare records over a video call, which was previously challenging due to limited computers. [ABSTRACT FROM AUTHOR]

In light of the coronavirus disease 2019 (COVID-19) pandemic, cancer centres in the United Kingdom and Europe re-organised their services at an unprecedented pace, and many patients with cancer have had their treatments severely disrupted. Patients with cancer were considered at high risk on sparse evidence, and despite a small number of emerging observational studies, the true incidence and impact of COVID-19 in the 'at-risk' population of patients with cancer is yet to be defined. Epidemiological and clinical data were collected prospectively for patients attending the Royal Marsden Hospital and three network hospitals between March 1st and April 30th 2020 that were confirmed to have Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection. Significance of clinical and pathological characteristics was assessed using the Fisher's exact test and Wilcoxon rank sum test, whilst univariate and multivariate logistic regression models were used to further assess risk. The number of patients attending in March/April 2020 for face-to-face attendances was also extracted. During the 2-month study period, 867 of 13,489 (6.4%) patients met the criteria leading to swab testing. Of the total at-risk population, only 113 of 13,489 (0.84%) were swab positive, 101 of 13,489 (0.75%) required hospital admission and 29 of 13,489 (0.21%) died of COVID-19. Of the patients that attended the hospital to receive cytotoxic chemotherapy alone or in combination with other therapy, 59 of 2001 (2.9%) were admitted to the hospital for COVID-19–related issues and 20 of 2001 (1%) died. Of the patients that collected targeted treatments, 16 of 1126 (1.4%) were admitted and 1 of 1126 (0.1%) died. Of the 11 patients that had received radiotherapy, 6 of 1042 (0.6%) required inpatient admission and 2 of 1042 (0.2%) died. Administration of systemic anticancer therapy appears to be associated with a modest risk of severe COVID-19 infection. Based on this snapshot taken as the first wave of COVID-19 hit our practice, we conclude that continuation of active cancer treatment, even in the palliative setting, is appropriate. • Of 13,489 cancer patients, 867 were tested and 113 were coronavirus disease 2019 (COVID-19) swab-positive. • Of these only 101 patients required hospital admission and 29 died of COVID-19. • Systemic anticancer therapy (SACT) and radiotherapy confer only a modest risk of significant COVID-19 infection. • Incidence of clinically significant COVID-19 was as in the general population. • We encourage oncology centres to continue to deliver SACT and radiotherapy. [ABSTRACT FROM AUTHOR]