Challenges in Antimicrobial Stewardship: Rapid Diagnostics and Optimization of Therapy Among Immunocompromised Patients

Rosa, Rossana; Suárez, José Francisco; Bravo, Gabriela; Morillas-Rodriguez, Jose A; Anderson, Anthony D.; Camargo, José F.; Abbo, Lilian M.

doi:10.1093/ofid/ofz239

Cited by 6 publications

(7 citation statements)

References 5 publications

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“…In adult patients with FN, multiplex PCR systems reduced time to appropriate antibiotics but had limited impact on duration in two studies. 24 In contrast, a randomised trial of BioFire Filmarray coupled with a comprehensive AMS program in adult patients, including 40% who were immunocompromised, did show reductions in both areas. 25 While the data for rapid, molecular based diagnostics in paediatric FN are scant so far, these results highlight the importance of both diagnostic and AMS interventions to ensure appropriate use of these, often costly, tests.…”

Section: Diagnosis and Initial Investigation Of Fnmentioning

confidence: 92%

Optimising Antimicrobial Selection and Duration in the Treatment of Febrile Neutropenia in Children

Morgan¹,

Phillips²,

Haeusler³

et al. 2021

IDR

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Febrile neutropenia (FN) is a frequent complication of cancer treatment in children. Owing to the potential for overwhelming bacterial sepsis, the recognition and management of FN requires rapid implementation of evidenced-based management protocols. Treatment paradigms have progressed from hospitalisation with broad spectrum antibiotics for all patients, through to risk adapted approaches to management. Such risk adapted approaches aim to provide safe care through incorporating antimicrobial stewardship (AMS) principles such as implementation of comprehensive clinical pathways incorporating deescalation strategies with the imperative to reduce hospital stay and antibiotic exposure where possible in order to improve patient experience, reduce costs and diminish the risk of nosocomial infection. This review summarises the principles of risk stratification in FN, the current key considerations for optimising empiric antimicrobial selection including knowledge of antimicrobial resistance patterns and emerging technologies for rapid diagnosis of specific infections and summarises existing evidence on time to treatment, investigations required and duration of treatment. To aid treating physicians we suggest the key features based on current evidence that should be part of any FN management guideline and highlight areas for future research. The focus is on treatment of bacterial infections although fungal and viral infections are also important in this patient group.

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Section: Diagnosis and Initial Investigation Of Fnmentioning

confidence: 92%

Optimising Antimicrobial Selection and Duration in the Treatment of Febrile Neutropenia in Children

Morgan¹,

Phillips²,

Haeusler³

et al. 2021

IDR

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“…Additionally, a retrospective study from Rosa et al 68 of 95 patients with either hematological malignancy or HCT showed similar results of no benefit in time to appropriate therapy for BSIs with multiple polymerase chain reaction alone or in conjunction with ASP intervention. 68 However, the lack of additional benefit observed when BCID was paired with ASP might be attributed to the overall poor understanding of the appropriate use of RDTs among health care workers, as shown in a recent survey. 69 Further studies are needed to explore the advantages and limitations of RDTs in the oncology and HCT population as well as the impact of education about these technologies.…”

Section: Diagnostic Stewardshipmentioning

confidence: 92%

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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“…Moreover, a retrospective study by Rosa et al of 95 patients with hematologic malignancies or bone marrow transplantation showed no benefits over time for appropriate therapy using multiplex PCR blood panel identification alone or in conjunction with the ASP intervention [ 28 ]. There are limitations that may explain the non-benefit of BCID combined with ASP strategies, e.g., the general lack of understanding of these technologies among health workers.…”

Section: Discussionmentioning

confidence: 99%

Impact of Adding a Rapid PCR-Based Blood Culture Identification Panel to the Antimicrobial Stewardship Program of Patients with Febrile Neutropenia in a Peruvian Referral Hospital

et al. 2023

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The addition of Biofire® FilmArray® Blood Culture Identification panel 2 (BCID2) to the antimicrobial stewardship program (ASP) could improve outcomes in bloodstream infections (BSI) of patients with febrile neutropenia (FN). A pre- and post-quasi-experimental single-center study was conducted at a reference hospital in Peru. Three groups were considered: patients with BSI before ASP intervention (control group), patients with BSI after ASP intervention (group 1), and patients with BSI after ASP intervention plus BCID2 PCR Panel implementation (group 2). Overall, 93 patients were identified (32 control, 30 group 1, 31 group 2). The median time to effective therapy was significantly shorter in group 2 compared to group 1 and control group, respectively (3.75 vs. 10 h, p = 0.004; 3.75 vs. 19 h, p < 0.001). No significant differences in terms of relapse of bacteremia, in-hospital mortality (all cause), and 30-day-all-cause hospital readmission between the three study periods were found. The appropriateness of empirical antimicrobial use, adding or change, and the following de-escalation or discontinuation was significant when the two intervention periods were compared with the control group (p < 0.001). In addition to the lack of local studies documenting the microbiological profile of FN episodes, adding syndromic panels-based testing could allow for the consolidation of ASP strategies.

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Challenges in Antimicrobial Stewardship: Rapid Diagnostics and Optimization of Therapy Among Immunocompromised Patients

Cited by 6 publications

References 5 publications

Optimising Antimicrobial Selection and Duration in the Treatment of Febrile Neutropenia in Children

Optimising Antimicrobial Selection and Duration in the Treatment of Febrile Neutropenia in Children

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

Impact of Adding a Rapid PCR-Based Blood Culture Identification Panel to the Antimicrobial Stewardship Program of Patients with Febrile Neutropenia in a Peruvian Referral Hospital

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