A multidisciplinary approach to adequate antibiotic use in a clinical oncology ward.

Abstract

430 Background: Infectious complications are related to high morbidity and mortality among oncology patients. Despite prompt attention being given to its management, many times the prescription of antibiotics is inadequate or overuse, mainly in palliative care. A multidisciplinary team is essential to take care this complex patient and to support the best practice to antibiotic prescription. Methods: We established a multidisciplinary team with support of medical specialists in clinical oncology (physicians, nurses, pharmacies and residents) and infection control (physician and nurse) to evaluate the antibiotic use, indication and period of use based on local antibiotic stewardship guidelines. Antimicrobial consumption was assessed using Defined daily dose (DDD). A drive diagram was created, and the actions were implemented. The data were collected pre intervention (from January to October 2022) and post intervention (from November 2022 to May 2023). Results: The main therapeutic uses were identified as ceftriaxone (DDD = 134.26), piperacillin-tazobactam (DDD = 112.13), metronidazole (DDD = 134.26) meropenem (DDD= 27.14), and teicoplamine (DDD= 23.69). The final stages of life were the main offender based on our guideline. The average antimicrobial consumption during the final 72 hours of life was 41%. According to these data the following actions were taken: 1) improve the palliative risk identification system; 2) assess the pertinence of antimicrobial use in end-of-life care; 3) creation of the one protocol in this subgroup of patients 4) an applicative was created, allowing the insertion of the advice by the medical team and the follow-up by the pharmaceutical team. In post intervention period, with these multi modal strategies the average consumption in end-of-life care reduced to 18%. Conclusions: A creation of a multidisciplinary team in oncologic care with a particular focus in antibiotic stewardship improved the adherence antibiotics protocols and had an impact in patients end of life.