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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]

Graft-versus-host disease (Gv HD) is a common complication following haematopoietic stem cell transplant but little is published about the impact of this condition on hospital readmission rates. We report a retrospective analysis of readmission rates and associated costs in 187 consecutive allogeneic transplant patients to assess the impact of Gv HD. The overall readmission rate was higher in patients with Gv HD (86% (101/118) vs. 59% (41/69), p < 0.001). The readmission rate was higher both in the first 100 d from transplant (p = 0.02) and in the first year following transplant (p < 0.001). 151/455 (33%) of all readmission episodes occurred within 100 d of transplant. The mean number of inpatient days was significantly higher in patients with grade III/ IV acute Gv HD (101 d) compared with those with grade I/ II Gv HD (70 d; p = 0.003). The mean cost of readmission was higher in patients with Gv HD (£28 860) than in non- Gv HD patients (£13 405; p = 0.002) and in patients with grade III/ IV Gv HD (£40 012) compared with those patients with grade I/ II Gv HD (£24 560; p = 0.038). Survival was higher in those with grade I/ II Gv HD (55%) compared to grade III/ IV Gv HD (14%; p < 0.001). This study shows the high economic burden and poor overall survival associated with grade III/ IV Gv HD. [ABSTRACT FROM AUTHOR]