Antibiotic use in Greek Pediatric Hematology-Oncology and Bone Marrow
Transplantation units
Abstract
Background: Pediatric hematology-oncology (PHO) and bone marrow
transplantation (BMT) units have high use of antimicrobials. Objectives:
To survey antimicrobials used in Greek PHO and BMT units before and
after an intervention involving education on the 2017 clinical practice
guidelines (CPG) for the management of febrile neutropenia in children
with cancer and hematopoietic stem cell transplant recipients. Methods:
Antibiotic prescribing practices were prospectively recorded between
June 2016 and November 2017. In December 2017, education for the CPG
took place and antibiotic prescribing practices were followed for one
more year. For antibiotic stewardship, days of therapy and length of
therapy were calculated. Results: Five of six PHO units and the single
pediatric BMT unit covering >92% of children with
hematologic and oncologic diseases in Greece participated.
Administration of ≥ 4 antibiotics simultaneously and of antibiotics with
overlapping activity for ≥ 2 days was significantly more common in PHO
units located in general compared to pediatric hospitals. Use of at
least one antifungal was recorded in approximately 47% of the patients
before and after the intervention. De-escalation and/or discontinuation
of antibiotics on day 6 of initial treatment increased significantly
from 43% to 53.5% (p=0.032). Although the number of patients requiring
support in the intensive care unit for sepsis did not change, a
significant drop was noted in all-cause mortality after the intervention
(p=0.008). Conclusion: Our surveillance was able to accurately document
the antibiotic prescribing practices of Greek PHO and BMT units.
Moreover, it identified areas in immediate need for improvement in
antibiotic stewardship.