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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.

References

REFERENCES

1. Barlam, TF, Cosgrove, SE, Abbo, LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62:e51–e77.CrossRefGoogle Scholar
2. Mihu, C, Paskovaty, A, Seo, SK. Antimicrobial stewardship considerations for cancer centers. In: Safdar A, ed. Principles and Practice of Cancer Infectious Diseases. Totowa, NJ: Humana Press, 2011:491–498.CrossRefGoogle Scholar
3. Tverdek, FP, Rolston, KV, Chemaly, RF. Antimicrobial stewardship in patients with cancer. Pharmacotherapy 2012;32:722–734.Google Scholar
4. Abbo, LM, Ariza-Heredia, EJ. Antimicrobial stewardship in immunocompromised hosts. Infect Dis Clin North Am 2014;28:263–279.Google Scholar
5. Cosgrove, SE, Seo, SK, Bolon, MK, et al. Evaluation of postprescription review and feedback as a method of promoting rational antimicrobial use: a multicenter intervention. Infect Control Hosp Epidemiol 2012;33:374–380.Google Scholar
6. Paskovaty, A, Pastores, SM, Gedrimaite, Z, Kostelecky, N, Riedel, ER, Seo, SK. Antimicrobial de-escalation in septic cancer patients: is it safe to back down? Intensive Care Med 2015;41:2022–2023.CrossRefGoogle ScholarPubMed
7. Aitken, SL, Palmer, HR, Topal, JE, Gabardi, S, Tichy, E. Call for antimicrobial stewardship in solid organ transplantation. Am J Transplant 2013;13:2499.Google Scholar
8. National action plan for combating antibiotic-resistant bacteria. The White House website. https://www.whitehouse.gov/the-press-office/2015/03/27/fact-sheet-obama-administration-releases-national-action-plan-combat-ant. Published 2015. Accessed December 1, 2015.Google Scholar
9. Be the Match transplant center directory. National Marrow Donor Program website. https://bethematch.org/TCDirectory/Search. Accessed March 18, 2015.Google Scholar
10. Society for Healthcare Epidemiology of America, Infectious Diseases Society of America, Pediatric Infectious Diseases Society. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol 2012;33:322–327.Google Scholar
11. Hospital infection control worksheet. Centers for Medicare & Medicaid Services website. http://go.cms.gov/1B6NCSV. Accessed February 3, 2016.Google Scholar
12. Survey and CPOE materials. The Leapfrog Group website. http://www.leapfroggroup.org/survey-materials/survey-and-cpoe-materials. Accessed February 3, 2016.Google Scholar
13. Cervera, C, van Delden, C, Gavalda, J, et al. Multidrug-resistant bacteria in solid organ transplant recipients. Clin Microbiol Infect 2014;20(Suppl 7):S49–S73.Google Scholar
14. Kamboj, M, Son, C, Cantu, S, et al. Hospital-onset Clostridium difficile infection rates in persons with cancer or hematopoietic stem cell transplant: a C3IC network report. Infect Control Hosp Epidemiol 2012;33:1162–1165.Google Scholar
15. Macesic, N, Morrissey, CO, Cheng, AC, Spencer, A, Peleg, AY. Changing microbial epidemiology in hematopoietic stem cell transplant recipients: increasing resistance over a 9-year period. Transpl Infect Dis 2014;16:887–896.Google Scholar
16. Steinmann, J, Hamprecht, A, Vehreschild, MJ, et al. Emergence of azole-resistant invasive aspergillosis in HSCT recipients in Germany. J Antimicrob Chemother 2015;70:1522–1526.Google Scholar
17. Chou, S. Approach to drug-resistant cytomegalovirus in transplant recipients. Curr Opin Infect Dis 2015;28:293–299.CrossRefGoogle ScholarPubMed
18. Frobert, E, Burrel, S, Ducastelle-Lepretre, S, et al. Resistance of herpes simplex viruses to acyclovir: an update from a ten-year survey in France. Antiviral Res 2014;111:36–41.Google Scholar
19. Yeo, CL, Chan, DS, Earnest, A, et al. Prospective audit and feedback on antibiotic prescription in an adult hematology-oncology unit in Singapore. Eur J Clin Microbiol Infect Dis 2012;31:583–590.Google Scholar
20. Standiford, HC, Chan, S, Tripoli, M, Weekes, E, Forrest, GN. Antimicrobial stewardship at a large tertiary care academic medical center: cost analysis before, during, and after a 7-year program. Infect Control Hosp Epidemiol 2012;33:338–345.Google Scholar
21. Trubiano, JA, Leung, VK, Chu, MY, Worth, LJ, Slavin, MA, Thursky, KA. The impact of antimicrobial allergy labels on antimicrobial usage in cancer patients. Antimicrob Resist Infect Control 2015;4:23.Google Scholar
22. Tomblyn, M, Chiller, T, Einsele, H, et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant 2009;15:1143–1238.Google Scholar
23. Freifeld, AG, Bow, EJ, Sepkowitz, KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 2011;52:e56–e93.Google Scholar
24. Blumberg, EA, Danziger-Isakov, L, Kumar, D, Michaels, MG, Razonable, RR. Foreword: Guidelines 3. Am J Transplant 2013;13(Suppl 4):S1–S2.Google Scholar
25. Nucci, M, Landau, M, Silveira, F, Spector, N, Pulcheri, W. Application of the IDSA guidelines for the use of antimicrobial agents in neutropenic patients: impact on reducing the use of glycopeptides. Infect Control Hosp Epidemiol 2001;22:651–653.Google Scholar
26. Rosa, RG, Goldani, LZ, dos Santos, RP. Association between adherence to an antimicrobial stewardship program and mortality among hospitalised cancer patients with febrile neutropaenia: a prospective cohort study. BMC Infect Dis 2014;14:286.CrossRefGoogle Scholar
27. Pakakasama, S, Surayuthpreecha, K, Pandee, U, et al. Clinical practice guidelines for children with cancer presenting with fever to the emergency room. Pediatr Int 2011;53:902–905.CrossRefGoogle ScholarPubMed
28. Zuckermann, J, Moreira, LB, Stoll, P, Moreira, LM, Kuchenbecker, RS, Polanczyk, CA. Compliance with a critical pathway for the management of febrile neutropenia and impact on clinical outcomes. Ann Hematol 2008;87:139–145.CrossRefGoogle ScholarPubMed
29. Mondain, V, Lieutier, F, Hasseine, L, et al. A 6-year antifungal stewardship programme in a teaching hospital. Infection 2013;41:621–628.Google Scholar
30. Procop, GW, Winn, W; Microbiology Resource Committee, College of American Pathologists. Outsourcing microbiology and offsite laboratories: implications on patient care, cost savings, and graduate medical education. Arch Pathol Lab Med 2003;127:623–624.CrossRefGoogle ScholarPubMed
31. Wolf, J, Sun, Y, Tang, L, et al. Antimicrobial stewardship barriers and goals in pediatric oncology and bone marrow transplantation: a survey of antimicrobial stewardship practitioners. Infect Control Hosp Epidemiol 2016;37:343–347.Google Scholar