A change for the antibacterial treatment policy to decrease carbapenem consumption at a haematopoietic stem cell...

Area of Science:

• Infectious Diseases
• Hematology
• Antimicrobial Stewardship

Background:

• High rates of carbapenem-resistant Gram-negative bacilli infections in febrile neutropenic patients necessitate optimized treatment strategies.
• Previous empirical antibiotic regimens in haematopoietic stem cell transplantation (HSCT) settings contributed to rising antimicrobial resistance.
• The need for evidence-based guidelines to manage neutropenic fever while conserving broad-spectrum antibiotics is critical.

Purpose of the Study:

• To evaluate the impact of a two-stage intervention on antibiotic use in febrile neutropenic patients undergoing HSCT.
• To assess the effectiveness of a revised empirical antibiotic pathway in reducing carbapenem consumption.
• To analyze changes in antimicrobial resistance patterns and patient outcomes following the intervention.

Main Methods:

• Implementation of a two-stage intervention, shifting from carbapenems to piperacillin/tazobactam (TZP) for empirical neutropenic fever treatment.
• Defined criteria for escalating or de-escalating antibiotic therapy based on clinical status and microbiological data.
• Calculation of antibiotic consumption using defined daily dosages (DDD) per 1000 patient days for 2013 and 2014.

Main Results:

• Significant reduction in carbapenem (imipenem, meropenem) use by over 90% from 2013 to 2014 (p<0.001).
• Increased use of piperacillin/tazobactam (TZP) and amikacin, indicating a shift in empirical therapy (p<0.001).
• A decrease in the number of patient deaths during hospitalization from 24 in 2013 to 17 in 2014.

Conclusions:

• A febrile neutropenia pathway guided by local epidemiology and international guidelines can significantly reduce antibiotic use in HSCT patients.
• The intervention demonstrated success in optimizing antibiotic selection without compromising patient outcomes.
• Sustaining such antimicrobial stewardship initiatives requires robust multidisciplinary collaboration.