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. 2024 Nov 26;14(1):29296.
doi: 10.1038/s41598-024-80163-1.

Impact of a two step antimicrobial stewardship program in a paediatric haematology and oncology unit

Cecilia Liberati #  1 , Elisa Barbieri #  2 , Francesca Cavagnero  2 , Maria Grazia Petris  3 , Giulia Brigadoi  2 , Giulia Reggiani  3 , Marica De Pieri  2 , Marta Pierobon  3 , Antonio Marzollo  3 , Maria Gabelli  3 , Sabrina Trivellato  4 , Erika Rigotti  5 , Francesca Opri  5 , Daniele Mengato  4 , Francesca Venturini  4 , Ettore De Canale  6 , Claudia Del Vecchio  6 , Carlo Giaquinto  2 , Elena Carrara  7 , Evelina Tacconelli  7 , Alessandra Biffi #  8 , Daniele Donà #  2
Affiliations

Impact of a two step antimicrobial stewardship program in a paediatric haematology and oncology unit

Cecilia Liberati et al. Sci Rep. .

Abstract

Objective: To describe the implementation of a multi-step antimicrobial stewardship program in a haemato-oncology and stem cell transplantation program unit. Methods: Pre-post quasi-experimental study with two interrupted time-series analyses, conducted between 01/01/2019 and 31/12/2022 in the Paediatric Haemato-Oncology Unit of the Padua Paediatric Hospital. The interventions were: (1) 02/2020: dissemination of febrile neutropenia clinical pathways, (2) April 2021: provision of the clinical pathways via a customized App (Firstline.org) and implementation of a twice-a-week prospective audit and feedback. The main outcome was antibiotic consumption measured by days of administered therapy (DOTs)/1000 patients' days for all antibiotics and most used molecules.

Results: The first intervention (clinical pathways) resulted in a decrease in the overall antibiotic use by the haemato-oncology unit, with an abrupt reduction of 3-gen cephalosporins in favor of piperacillin-tazobactam, as indicated by the clinical pathways. Meropenem and glycopeptide use did not vary. The second intervention (antimicrobial stewardship) further decreased total antibiotic consumption, and a significant decline in meropenem, amikacin, and glycopeptides was achieved.

Conclusions: Multi-step stewardship based on guidelines dissemination, multidisciplinary team intervention and collaboration ("handshake" stewardship) was highly effective in optimizing guidelines adherence and reducing overprescriptions in a fragile patient cohort.

Keywords: Antibiotics.; Antimicrobial stewardship; Pediatric Oncology Haematology; Stem cell transplantation.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethical considerations: This study was conducted in accordance with the tenets of the Declaration of Helsinki. The study was granted approval by the ethical committee for clinical trials of the province of Padova on April 7th, 2022 (N. AOP2612). Informed consent: Patient informed consent was waived due to the retrospective nature of the study by the ethical committee for clinical trials of the province of Padova, and the use of wards aggregated data provided by thehospital pharmacy, in accordance with the ethical committee for clinical trials of the province of Padova

Figures

Fig. 1
Fig. 1
Interrupted time series of monthly antimicrobial consumption for the Haemato-Oncology ward (blue line) with reference monthly value and 95%CI (grey lines) for meropenem (A), piperacillin/tazobactam (B), third-generation cephalosporins (C), amikacin (D), glycopeptides (E) and quinolones (F). Orange box refers to the period from the first intervention (febrile neutropenia protocol dissemination) and the second intervention (Antimicrobial Stewardship program, ASP). The green box refers to the post-ASP intervention.
Fig. 2
Fig. 2
Interrupted time series of monthly antimicrobial consumption for the Haematopoietic Stem Cell Transplantation (HSCT) Unit (blue line) with reference monthly value and 95%CI (grey lines) for meropenem (A), piperacillin/tazobactam (B), third-generation cephalosporins (C), amikacin (D), glycopeptid€(E) and quinolones (F). Orange box refers to the period from the first intervention (febrile neutropenia protocol dissemination) and the second intervention (Antimicrobial Stewardship program, ASP). The green box refers to the post-ASP intervention.
See this image and copyright information in PMC

References

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