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Published on: August 30, 2018
Implementing a Personalized Antimicrobial Stewardship Program for Women with Gynecological Cancers and
Simona Di Giambenedetto1,2, Alberto Borghetti1, Lorena Quagliozzi3
1UOC Malattie Infettive, Dipartimento di Scienze di Laboratorio ed Infettivologiche, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Roma, Italy.
Insights
Healthcare-associated infections (HCAIs) in gynecologic cancer patients can be effectively managed. A multidisciplinary antimicrobial stewardship program achieved clinical cure for all patients, reducing hospital stays.
Area of Science:
- Oncology
- Infectious Diseases
- Antimicrobial Stewardship
Background:
- Healthcare-associated infections (HCAIs) are a significant cause of illness and death in gynecologic cancer patients.
- Personalized treatment strategies are crucial for managing HCAIs in this vulnerable population.
Purpose of the Study:
- To evaluate the effectiveness of an antimicrobial stewardship program in managing HCAIs in gynecologic cancer patients.
- To assess clinical cure rates, infection relapse, mortality, and hospital stay duration.
Main Methods:
- Retrospective study of 27 gynecologic cancer patients with HCAIs.
- Infectious disease specialist evaluation and management.
- Focus on complicated urinary tract infections (cUTIs) and bloodstream infections (BSIs).
- Utilized outpatient parenteral antimicrobial therapy (OPAT) and inpatient management with source control and wound care.
Main Results:
- All 27 patients achieved clinical cure.
- No breakthrough infections occurred; one relapse and one non-infection-related death were observed.
- Outpatient management with OPAT was successful for 15 patients (73.3% of cUTIs).
- Inpatient management for 12 patients (primarily BSIs) resulted in a median 5-day reduction in hospital stay with antimicrobial therapy.
Conclusions:
- A patient-centered, multidisciplinary antimicrobial stewardship program is effective for managing HCAIs in gynecologic cancer patients.
- OPAT can be a viable option for select HCAIs, reducing the need for hospitalization.
- Integrated care including source control and wound management is essential for successful outcomes.
Abstract:
Healthcare-associated infections (HCAIs) represent a major cause of morbidity and mortality in gynecologic cancer patients, requiring personalized cures. A retrospective study on gynecologic patients with HCAIs, managed through an antimicrobial stewardship program, was performed, focusing on rates of clinical cure, breakthrough/relapse of infections, death, and time of hospital stay (THS). In total, 27 patients (median 60 years, mainly suffering from ovarian, cervical, and uterine cancer) were evaluated by a specialist in infectious diseases and were mainly diagnosed with complicated urinary tract (cUTIs, 12 cases, 44.4%) and bloodstream infections (BSIs, 9 cases, 33.3%). A total of 15 cases (11 cUTIs, 73.3%) were managed with no need for hospitalization and received a median of 11 days of outpatient parenteral antimicrobial therapy (OPAT). In the remaining 12 cases (BSIs in 8 cases, 66.7%), the median THS was 11 days, with 15 days median overall duration of antimicrobial therapy (median 5-day reduction in THS). The management of patients also included source control and wound care. All patients reached clinical cure, with no case of breakthrough infection, one case of relapse, and one death within 30 days (not attributable to the infection). HCAIs in patients with gynecologic tumors can be managed through a patient-centered, multidisciplinary antimicrobial stewardship program.
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