Antimicrobial Stewardship in Patients with Hematological Malignancies: Key Considerations

So, Miranda

doi:10.1007/s40506-019-00189-2

Cited by 4 publications

(8 citation statements)

References 80 publications

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“…Furthermore, reducing antibiotic consumption in patients with FN has previously been reported as cost-saving [ 5 ]. Finally, vancomycin, the most used glycopeptide in patients with febrile neutropenia [ 15 ], is known to be associated with side effects such as acute kidney injury by direct renal toxicity or secondary to a drug-drug interaction with piperacillin [ 16 , 17 ]. All these data suggest that decreasing antibiotic exposure, especially to carbapenems and glycopeptides, may be beneficial for FN patients in multiple ways.…”

Section: Discussionmentioning

confidence: 99%

“…In this specific population, AMS programs have been recently implemented in several hematology units, with very encouraging results [ 5 , 14 , 19 ]. Published data suggest that AMS interventions in hematology are safe and well accepted by clinicians, but knowledge gaps persist regarding antibiotics de-escalation and discontinuation strategies in high-risk FN patients [ 15 , 18 ]. Broad development and evaluation of multidisciplinary AMS programs in this population of patients is thus warranted [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

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Antimicrobial stewardship in high-risk febrile neutropenia patients

Contejean

Abbara

Alviset

et al. 2022

Antimicrob Resist Infect Control

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Background The 2011 4th European Conference on Infections in Leukemia (ECIL4) guidelines recommend antibiotics de-escalation/discontinuation in selected febrile neutropenia (FN) patients. We aimed to assess the impact of an antimicrobial stewardship (AMS) program based on these guidelines on antibiotics use and clinical outcomes in high-risk FN patients. Methods We conducted an observational study in the hematology department of Cochin University Hospital in Paris, France. An ECIL4-based antibiotics de-escalation and discontinuation strategy was implemented jointly by the hematologists and the AMS team. The pre-intervention (January–October 2018) and post-intervention (January-October 2019) periods were compared. We retrospectively collected clinical and microbiological data. We compiled antibiotics consumptions via hospital pharmacy data and standardized them by calculating defined daily doses per 1000 patient-days. We analyzed the two-monthly antibiotic consumption using an interrupted time series method and built a composite endpoint for clinical outcomes based on transfer to the intensive care unit (ICU) and/or hospital death. Results Overall, 273 hospital stays (164 patients) in the pre-intervention and 217 (148 patients) in the post-intervention periods were analyzed. Patients were mainly hospitalized for intensive chemotherapy for acute leukemia or autologous stem-cell transplant for myeloma. Patients were slightly younger in the pre-intervention compared to the post-intervention period (median age 60.4 vs 65.2 years, p = 0.049), but otherwise comparable. After implementation of the AMS program, glycopeptide and carbapenem use decreased by 85% (p = 0.03) and 72% (p = 0.04), respectively. After adjustment on confounders, the risk of transfer to the ICU/death decreased significantly after implementation of the AMS program (post-intervention period: odds-ratio = 0.29, 95% Confidence Interval: 0.15–0.53, p < 0.001). Conclusion Implementation of a multidisciplinary AMS program for high-risk neutropenic patients was associated with lower carbapenem and glycopeptide use and improved clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Antimicrobial stewardship in high-risk febrile neutropenia patients

Contejean

Abbara

Alviset

et al. 2022

Antimicrob Resist Infect Control

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“…Hematological malignancies and HSCT double CDI risks due to exposure to healthcare facilities, disruption of the microbiome from broad-spectrum antimicrobials and chemotherapy, and are associated with higher mortality [9].…”

Section: Discussionmentioning

confidence: 99%

“…The strategy of audit and feedback or post-prescription review is effective in reducing antimicrobial consumption in patients with hematological malignancies [9].…”

Section: Discussionmentioning

confidence: 99%

“…In leukemia and malignant hematology and stem cell transplant (HSCT) patients vancomycin-resistant enterococcus (VRE) bloodstream infections were associated with a 2.9-fold increase in mortality and morbidity compared in patients without VRE infections. Established ASP in the HSCT population such as prior approval and post prescription review is feasible, effective, and safe in this patient population [9].…”

Section: Introductionmentioning

confidence: 99%

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Impact of an antimicrobial stewardship program in the antimicrobial-resistant and prevalence of clostridioides difficile infection and amount of antimicrobial consumed in cancer patients

2020

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Objective The The impact of a hospital antimicrobial stewardship was determined on antimicrobial-resistant, Clostridioides difficile rates and the amount of antimicrobial consumed in cancer patients.The intervention effects of antimicrobial stewardship (ASP) plans in 2017–2018 and 2018–2019 were respectively evaluated among hematology/oncology and bone marrow transplant patients in Ayatollah Taleghani University Hospital, Tehran, Iran. In this interventional quasi-experimental study, the ASP repository was utilized to capture four survey questions encompassed in these immunocompromised patients: amount of antibiotics (meropenem and vancomycin) consumption gr-year, the number of positive Clostridioides difficile infection and multidrug-resistant positive cases in blood cultures. Results The number of MDR cases in the periods of 2017–2018 and 2018–2019 were 145 and 75, respectively (p = 0.011). A significant reduction in all positive blood cultures from 2017–2018 to 2018–2019 was found (p = 0.001). 574 patients admitted to our hospital in these periods of 2017- 2018 and 2018- 2019were assessed for MPM and VMN use. The amounts of MPM prescriptions in 2018–2019 was significantly decreased from 22464 to 17262 g (p = 0.043). The significant reduction in antibiotic consumption, MDR organisms, and CDI can highly promote patients’ health and decreasing medical costs and long-term defects for patients.

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Advances in antibacterial treatment of adults with high-risk febrile neutropenia

Contejean

Maillard

Canouï

et al. 2023

Journal of Antimicrobial Chemotherapy

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Background High-risk febrile neutropenia (HR-FN) is a life-threatening complication in patients with haematological malignancies or receiving myelosuppressive chemotherapy. Since the last international guidelines were published over 10 years ago, there have been major advances in the understanding and management of HR-FN, including on antibiotic pharmacokinetics and discontinuation/de-escalation strategies. Objectives Summarizing major advances in the field of antibacterial therapy in patients with HR-FN: empirical therapy, pharmacokinetics of antibiotics and antibiotic stewardship. Sources Narrative review based on literature review from PubMed. We focused on studies published between 2010 and 2023 about the pharmacokinetics of antimicrobials, management of antimicrobial administration, and discontinuation/de-escalation strategies. We did not address antimicrobial prophylaxis, viral or fungal infections. Content Several high-quality publications have highlighted important modifications of antibiotic pharmacokinetics in HR-FN, with standard dosages exposing patients to underdosing. These recent clinical and population pharmacokinetics studies help improve management protocols with optimized initial dosing and infusion rules for β-lactams, vancomycin, daptomycin and amikacin; they highlight the potential benefits of therapeutic drug monitoring. A growing body of evidence also shows that antibiotic discontinuation/de-escalation strategies are beneficial for bacterial ecology and patients’ outcome. We further discuss methods and limitations for implementation of such protocols in haematology. Implications We highlight recent information about the management of antibacterial therapy in HR-FN that might be considered in updated guidelines for HR-FN management.

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Antimicrobial Stewardship in Patients with Hematological Malignancies: Key Considerations

Cited by 4 publications

References 80 publications

Antimicrobial stewardship in high-risk febrile neutropenia patients

Antimicrobial stewardship in high-risk febrile neutropenia patients

Impact of an antimicrobial stewardship program in the antimicrobial-resistant and prevalence of clostridioides difficile infection and amount of antimicrobial consumed in cancer patients

Advances in antibacterial treatment of adults with high-risk febrile neutropenia

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