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Observational Study
. 2022 Mar 26;11(1):52.
doi: 10.1186/s13756-022-01084-0.

Antimicrobial stewardship in high-risk febrile neutropenia patients

Adrien Contejean  1   2   3 , Salam Abbara  4   5 , Ryme Chentouh  6 , Sophie Alviset  6 , Eric Grignano  7 , Nabil Gastli  8 , Anne Casetta  9 , Lise Willems  7 , Etienne Canouï  6 , Caroline Charlier  10   6   11 , Frédéric Pène  10   12 , Julien Charpentier  12 , Jeanne Reboul-Marty  13 , Rui Batista  14 , Didier Bouscary  10   7 , Solen Kernéis  6   5   15
Affiliations
Observational Study

Antimicrobial stewardship in high-risk febrile neutropenia patients

Adrien Contejean et al. Antimicrob Resist Infect Control. .

Abstract

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.

Keywords: Antibiotic consumption; Antimicrobial stewardship; High-risk febrile neutropenia; Prognosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Segmented linear regression of antibiotics consumption during study period in defined daily dose per 1000 patient-days over time. A Aminoglycosides; B Carbapenems; C Class 3 β-lactams (third-generation cephalosporins or ureido/carboxy-penicillins); D Class 4 β-lactams (piperacillin/tazobactam, fourth-generation cephalosporins and antipseudomonal third-generation cephalosporins), E Fluoroquinolones; F Glycopeptides. Solid lines represent the crude 2-months antibiotic consumption. The dashed lines represent the linear regression for each period
Fig. 2
Fig. 2
Kaplan–Meier curves for occurrence of a negative outcome (ICU transfer for more than 24 h or death). A: Overall study population; B: Hospital stays with at least one febrile episode. Log-rank tests were used for statistical comparisons. Faded areas represent the 95% confident interval of each curve
See this image and copyright information in PMC

References

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