Carbapenem use in the setting of hematologic disorders was reduced after an antimicrobial stewardship team (AST) intervention, according to results of a study published in Antibiotics.
Infectious complications are common in hematologic malignancies however, management of these complications with broad-spectrum antibiotics can negatively affect resistance rates and allergic or toxic complications in patients.
Due to the importance of antimicrobials in the setting of hematologic disorders, an AST intervention was established at a center in Japan. In this study, carbapenem use prior to the AST intervention (April 2016 through March 2018) was compared with carbapenem use after the AST intervention (April 2018 through March 2021) to determine its effect on carbapenem use.
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The study population comprised 264 patients, aged 72.5 years (range, 24 to 94), 59.5% were men, 31.8% had malignant lymphoma, 29.2% had acute myeloid leukemia, and 11.4% had myelodysplastic syndrome.
After the AST intervention, both days of therapy and use density for carbepenem decreased significantly (both, P ≤.023). The post-AST group had a higher rate of blood culture prior to antibiotic use (P <.001) and a higher blood culture positivity rate (P =.003) compared with pre-AST group.
Overall, there were 286 cases of carbapenem use for more than 8 days and 233 cases of use for less than 7 days.
In the multivariate analysis, predictors for receiving carbapenem therapy for more than 8 days included chronic obstructive pulmonary disease (b, 2.132; P =.043), infection with resistant bacteria (b, 1.036; P =.004), acute myeloid leukemia (b, 0.539; P =.029), outpatient onset (b, 0.533; P =.038), and multiple myeloma (b, −1.010; P =.011).
This study may have been biased. The rate of stem cell transplantation was higher in post-AST cohort, which may have indicated those patients were more seriously ill.
The study authors concluded that comparisons of the pre- and postintervention periods showed that use of an AST decreased carbapenem use and increased blood culture collection in patients with hematologic disorders.
Reference
Suzuki A, Yamaguchi F, Maeda M, et al. Antimicrobial stewardship program for patients in the hematological department receiving carbapenem therapy: a single-center and interrupted time series analysis. Antibiotics. 2023;12(2):302. doi:10.3390/antibiotics12020302
This article originally appeared on Oncology Nurse Advisor
