Antimicrobial Stewardship Opportunities in Non-Neutropenic Oncology Patients

Antibiotic stewardship programs are most often focused on use in more general populations and there is typically hesitancy when it comes to assessing immunocompromised populations.

However, there is an opportunity to improve antibiotic use and patient outcomes in immunocompromised patients.

Investigators from Wayne State University, in collaboration with Henry Ford Hospital in Michigan, have recently conducted a study that sought to identify areas of opportunity for improvement in antimicrobial use in inpatient oncology patients.

The data was presented at the 23rd Annual Making a Difference in Infectious Disease Meeting 2021 virtual sessions.

The cross-sectional, cohort study included 200 oncology patients who were admitted to a large tertiary care academic medical center between August 1, 2018, and August 30, 2019. All participants were over the age of 18, had an oncologic history and received an antimicrobial agent.

Of the study participants, 77 had pulmonary infections, 34 had Intra-abdominal infections, 31 had urinary tract infections, 23 were septic, and 35 were categorized as other.

Findings showed that a total of 84 of the participants had at least one opportunity to improve their antibiotic regimen. Of those, empiric coverage discordance was the most common area for improvement.

Additionally, 83 of the participants experienced antibiotic related adverse events and 19 developed multidrug-resistant organisms (MDRO) within 90-days after their antibiotic therapy.

“This study identified that 42% of patients had an opportunity to improve at least one component of their antibiotic regimen,” the authors wrote. “Opportunities for improvement include assessing allergy history, optimizing empiric antibiotic coverage, avoiding dual anaerobic coverage, de-escalating based on microbiology cultures and susceptibilities, and switching from IV to oral therapies.”