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Current State of Antimicrobial Stewardship at Solid Organ and Hematopoietic Cell Transplant Centers in the United States

Published online by Cambridge University Press:  26 July 2016

Susan K. Seo ,
Kaming Lo  and
Lilian M. Abbo
Susan K. Seo*
Affiliation:
Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
Kaming Lo
Affiliation:
Division of Biostatistics, Biostatistics Collaboration and Consulting Core, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
Lilian M. Abbo
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
*
Address correspondence to Susan Seo, MD, 1275 York Ave, New York, NY 10065 ([email protected]).
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Abstract

OBJECTIVE

To assess the extent of antimicrobial stewardship programs (ASPs) at solid organ transplant (SOT) and hematopoietic cell transplant (HCT) centers in the United States.

DESIGN

An 18-item voluntary survey was developed to gauge current antimicrobial stewardship practices in transplant patients, examine the availability and perceived usefulness of novel diagnostics and azole levels to guide therapy, and identify challenges for implementation of ASPs at these centers.

PARTICIPANTS

The survey was distributed electronically to infectious disease physicians and pharmacists at adult and pediatric SOT and HCT centers during May 1–22, 2015. Facilities were deidentified.

RESULTS

After duplicate removal, 71 (56%) of 127 unique transplant centers in 32 states were analyzed. Forty-four sites (62%) performed at least 100 SOT annually, and 40 (56%) performed at least 100 HCT annually. Top 5 stewardship activities encompassing transplant patients were formulary restriction, guideline development, prospective audit and feedback, education, and dose optimization. Respiratory viral panels (66/66 [100%]), azole levels (64/66 [97%]), and serum/bronchoalveolar lavage galactomannan (58/66 [88%]) were perceived as most useful to guide therapy. Apparent challenges to antimicrobial stewardship included undefined duration for certain infections (53/59 [90%]), diagnostic uncertainty (47/59 [80%]), the perception that antibiotic-resistant infections required escalation (42/59 [71%]), prescriber opposition (41/59 [69%]), and costly drugs (37/59 [63%]).

CONCLUSIONS

ASP activities were performed at many adult and pediatric SOT and HCT centers in the United States. Diagnostic and therapeutic uncertainty in transplant patients is challenging for ASPs. Collaborative research should examine the impact of antimicrobial stewardship practices in SOT and HCT.

Infect Control Hosp Epidemiol 2016;1–6

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 10 , October 2016 , pp. 1195 - 1200
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

Presented in part: IDWeek 2015; San Diego, CA; October 7-11, 2015 (poster 189).

This article has the endorsement of the American Society of Transplantation Board of Directors and the leadership of the American Society of Transplantation Infectious Disease Community of Practice.

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