Related Experiment Video
Updated: Jun 6, 2025
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Impact of a two step antimicrobial stewardship program in a paediatric haematology and oncology unit
Cecilia Liberati1, Elisa Barbieri2, Francesca Cavagnero2
1Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University of Padova, Via Giustiniani 3 Padua, 35141, Padova, Italy. cecilia.liberati@unipd.it.
Insights
Implementing a multi-step antimicrobial stewardship program significantly reduced antibiotic use in pediatric haemato-oncology patients. This approach optimized guideline adherence and decreased overprescriptions in this vulnerable population.
Area of Science:
- Paediatric Haemato-Oncology
- Antimicrobial Stewardship
- Infectious Disease Management
Background:
- Haemato-oncology and stem cell transplantation (HSCT) patients are at high risk for infections.
- Optimizing antimicrobial use is crucial to combat resistance and improve patient outcomes.
Purpose of the Study:
- To describe the implementation of a multi-step antimicrobial stewardship program.
- To evaluate the impact of interventions on antibiotic consumption in a paediatric haemato-oncology unit.
Main Methods:
- A pre-post quasi-experimental study with interrupted time-series analyses (01/01/2019–31/12/2022).
- Interventions included dissemination of febrile neutropenia clinical pathways and a customized App with prospective audit and feedback.
- Antibiotic consumption measured by days of therapy (DOTs)/1000 patient days.
Main Results:
- The first intervention (clinical pathways) decreased overall antibiotic use, favoring piperacillin-tazobactam over 3rd-generation cephalosporins.
- The second intervention (stewardship program) further reduced total antibiotic consumption.
- Significant declines in meropenem, amikacin, and glycopeptide use were observed.
Conclusions:
- A multi-step stewardship program, including guideline dissemination and multidisciplinary collaboration, effectively optimized antimicrobial use.
- The program demonstrated high effectiveness in improving guideline adherence and reducing antibiotic overprescription in a fragile patient cohort.
Objective:
To describe the implementation of a multi-step antimicrobial stewardship program in a haemato-oncology and stem cell transplantation program unit. Methods: Pre-post quasi-experimental study with two interrupted time-series analyses, conducted between 01/01/2019 and 31/12/2022 in the Paediatric Haemato-Oncology Unit of the Padua Paediatric Hospital. The interventions were: (1) 02/2020: dissemination of febrile neutropenia clinical pathways, (2) April 2021: provision of the clinical pathways via a customized App (Firstline.org) and implementation of a twice-a-week prospective audit and feedback. The main outcome was antibiotic consumption measured by days of administered therapy (DOTs)/1000 patients' days for all antibiotics and most used molecules.
Results:
The first intervention (clinical pathways) resulted in a decrease in the overall antibiotic use by the haemato-oncology unit, with an abrupt reduction of 3-gen cephalosporins in favor of piperacillin-tazobactam, as indicated by the clinical pathways. Meropenem and glycopeptide use did not vary. The second intervention (antimicrobial stewardship) further decreased total antibiotic consumption, and a significant decline in meropenem, amikacin, and glycopeptides was achieved.
Conclusions:
Multi-step stewardship based on guidelines dissemination, multidisciplinary team intervention and collaboration ("handshake" stewardship) was highly effective in optimizing guidelines adherence and reducing overprescriptions in a fragile patient cohort.
Related Concept Videos
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:26Standard Precaution
Hand hygiene is the most crucial means to prevent the transmission of disease. Employers are legally required to provide their workers with personal protective equipment (PPE) to minimize exposure or contact with...
01:25Transmission-based Precautions II: Airborne and Protective Environment
Airborne precautions:
Use airborne precautions when treating patients known or suspected to have diseases that spread through the air—for example, tuberculosis or measles. These organisms are present in smaller droplets expelled by an infected person and...
01:28Pulmonary Tuberculosis V
Latent tuberculosis infection occurs when TB bacteria are present in a person's body, but are not causing illness or symptoms. It is not contagious, and preventive treatment is crucial to avoid the...
01:23Hand hygiene
Hand washing...