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Antimicrobial Stewardship in a Hematological Malignancy Unit: Carbapenem Reduction and Decreased Vancomycin-Resistant Enterococcus Infection
- Source :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 71(4)
- Publication Year :
- 2019
-
Abstract
- Background Antibiotic stewardship is challenging in hematological malignancy patients. Methods We performed a quasiexperimental implementation study of 2 antimicrobial stewardship interventions in a hematological malignancy unit: monthly antibiotic cycling for febrile neutropenia that included cefepime (± metronidazole) and piperacillin-tazobactam and a clinical prediction rule to guide anti-vancomycin-resistant Enterococcus faecium (VRE) therapy. We used interrupted time-series analysis to compare antibiotic use and logistic regression in order to adjust observed unit-level changes in resistant infections by background community rates. Results A total of 2434 admissions spanning 3 years pre- and 2 years postimplementation were included. Unadjusted carbapenem and daptomycin use decreased significantly. In interrupted time-series analysis, carbapenem use decreased by −230 days of therapy (DOT)/1000 patient-days (95% confidence interval [CI], −290 to −180; P < .001). Both VRE colonization (odds ratio [OR], 0.64; 95% CI, 0.51 to 0.81; P < .001) and infection (OR, 0.41; 95% CI, 0.2 to 0.9; P = .02) decreased after implementation. This shift may have had a greater effect on daptomycin prescribing (−160 DOT/1000 patient-days; 95% CI, −200 to −120; P < .001) than did the VRE clinical prediction score (−30 DOT/1000 patient-days; 95% CI, −50 to 0; P = .08). Also, 46.2% of Pseudomonas aeruginosa isolates were carbapenem-resistant preimplementation compared with 25.0% postimplementation (P = .32). Unit-level changes in methicillin-resistant Staphylococcus aureus and extended-spectrum beta lactamase (ESBL) incidence were explained by background community-level trends, while changes in AmpC ESBL and VRE appeared to be independent. The program was not associated with increased mortality. Conclusions An antibiotic cycling-based strategy for febrile neutropenia effectively reduced carbapenem use, which may have resulted in decreased VRE colonization and infection and perhaps, in turn, decreased daptomycin prescribing.
- Subjects :
- 0301 basic medicine
Microbiology (medical)
Methicillin-Resistant Staphylococcus aureus
medicine.medical_specialty
Carbapenem
medicine.drug_class
Cefepime
030106 microbiology
Antibiotics
medicine.disease_cause
03 medical and health sciences
Antimicrobial Stewardship
0302 clinical medicine
Vancomycin
Internal medicine
Medicine
Humans
Vancomycin-resistant Enterococcus
030212 general & internal medicine
Gram-Positive Bacterial Infections
biology
business.industry
biochemical phenomena, metabolism, and nutrition
bacterial infections and mycoses
biology.organism_classification
medicine.disease
Anti-Bacterial Agents
Infectious Diseases
Carbapenems
Hematologic Neoplasms
Piperacillin/tazobactam
Daptomycin
business
Febrile neutropenia
medicine.drug
Enterococcus faecium
Subjects
Details
- ISSN :
- 15376591
- Volume :
- 71
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
- Accession number :
- edsair.doi.dedup.....0af20e557be963a59789ebccc248d194