Density of antibiotic use and infectious complications in pediatric allogeneic hematopoietic cell transplantation

Abstract

Background Antibiotics, while an essential component of supportive care in allogeneic hematopoietic cell transplantation (allo‐HCT), can have adverse effects and select for antibiotic resistance. Understanding of patterns of use will inform antimicrobial stewardship (AMS) interventions. Methods Retrospective, single‐center cohort of children undergoing first allo‐HCT (n = 125). Antibiotic prescription and infection data were included from the date conditioning was commenced until 30 days post allo‐HCT. Antibiotic use was reported as length of therapy (LOT) (number of days a patient received an antibiotic) and days of therapy DOT (aggregating all antibiotics prescribed per day). Infections were classified as microbiologically documented infection (MDI) or clinically documented infections. Results At least one course of antibiotics was administered to 124 (99%) patients. The LOT was 636 per 1000 patient days and DOT was 959 per 1000 patient days. The median duration of cumulative antibiotic exposure per patient was 24 days (interquartile range [IQR] 20–30 days). There were 131 days of fever per 1000 patient days with patients febrile for a median of 4 days (IQR 1–7 days). Piperacillin–tazobactam was used for 116 (94%) of patients with an LOT of 532 per 1000 patient days. A total of 119 MDI episodes occurred in 74 (59%) patients, including blood stream infection in 30 (24%) and a proven/probable invasive fungal infection in 4 (3%). Conclusion Pediatric HCT patients receive prolonged courses of broad‐spectrum antibiotics relative to the frequency of fever and bacterial infections. This study has identified opportunities for AMS intervention to improve outcomes for our HCT patients.

Stopping antibacterial prophylaxis in pediatric allogeneic hematopoietic cell transplantation: An internal audit

“…24 days; consider a median of 44 vs. a fixed 30 days of follow up), and the rate of bloodstream infections (27 vs. 24%) and IFDs (2 vs. 3%). 43 Of note, compared with multicentric data, 41 the occurrence of resistant patient isolates was sporadic in our study, and the rate of C. difficile documentation of 5% was well below of those reported in large reviews. [44][45][46] In conclusion, the stop of routine antibacterial prophylaxis in a population of unselected pediatric patients undergoing allogeneic HCT had no apparent effect on the occurrence of fever, bacterial infections, resistant colonizers, and GVHD.…”

“…Infection‐ and resistance rates are difficult to compare across geographical regions and healthcare systems and definitions of outcomes and time points for measuring outcomes often vary. However, a comparison of some of our key data with those of a recent report on antibiotic use and infectious complications until day +30 posttransplant in pediatric allogeneic HCT patients from a single center in Melbourne reveals many similarities, including the rate of patients receiving at least one course of antibacterial treatment (98 vs. 99%), the median number of days of cumulative antibiotic exposure (36 vs. 24 days; consider a median of 44 vs. a fixed 30 days of follow up), and the rate of bloodstream infections (27 vs. 24%) and IFDs (2 vs. 3%) 43 . Of note, compared with multicentric data, 41 the occurrence of resistant patient isolates was sporadic in our study, and the rate of C. difficile documentation of 5% was well below of those reported in large reviews 44–46 …”