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

alexandrossfakianakis shared this article with you from Inoreader Density of antibiotic use and infectious complications in pediatric allogeneic hematopoietic cell transplantationa via Transplant Infectious Disease Abstract Background : Antibiotics, while an essential component of supportive care in allogeneic hematopoietic cell transplant (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 days a patient received an antibiotic) and days of therapy (DOT (aggregating all antibiotics prescribed per day). Infections were classified as microbiologically documented (MDI) or clinically documented infections (CDI). 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 (inter-quartile range (IQR) 20 – 30 days). There were 131 days of fever per 1000 patient days with patients febrile for a median of four days (IQR 1–7 days). Piperacillin-tazobactam was used for 116 (94%) of patients with a 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 four (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. This article is protected by copyright. All rights reserved View on Web

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