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

Andrew, EC; Khaw, SL; Hanna, D; Conyers, R; Fleming, J; Hughes, D; Toro, C; Wang, SS; Weerdenburg, H; Anderson, S; Cole, T; Haeusler, GM

Author(s): Andrew, EC; Khaw, SL; Hanna, D; Conyers, R; Fleming, J; Hughes, D; Toro, C; Wang, SS; Weerdenburg, H; Anderson, S; Cole, T; Haeusler, GM;
Details: Publication Year 2023-04,Volume 25,Issue #2,Page e14018
Journal Title: Transplant Infectious Disease
Publication Type: Research article
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.
Publisher: Wiley
Keywords: Humans; Child; Anti-Bacterial Agents/therapeutic use; Retrospective Studies; *Bacterial Infections/drug therapy/epidemiology/etiology; Fever/etiology; *Hematopoietic Stem Cell Transplantation/adverse effects; antibiotics; infections; microbiome; pediatrics; stem-cell transplantation
Department(s): Infectious Diseases
PubMed ID: 36748726
Publisher's Version: https://doi.org/10.1111/tid.14018
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2023-07-18 07:52:27

Last Modified: 2023-07-18 07:52:55