Abstract
In cancer patients, appropriate diagnosis and management of infection are frequently challenging owing to subtle or atypical presentation. We investigated the effectiveness of infectious disease (ID) consultations and the Antimicrobial Stewardship Program (ASP) in a Japanese cancer center. This 36-month-period, single-institution, interrupted time series analysis was retrospectively conducted during April 1, 2018-March 31, 2021, to evaluate a two-phase intervention: Phase 1 (notification of antimicrobials by the infection control team) and Phase 2 (establishing an ID consultation service and implementing ASP). Among 32,202 patients hospitalized, 22,096 and 10,106 hospitalizations occurred at baseline and during intervention period, respectively. The Antimicrobial Stewardship Team (AST) provided feedback on specific broad-spectrum antimicrobials in 913 instances (347 appropriate [38%]; 566 inappropriate [62%]), and 440 ID consultations were completed, with a 75% overall acceptance rate for AST suggestions. In Phase 2, monthly carbapenem days of therapy (CAR-DOT) decreased significantly, and narrow-spectrum antibiotic usage increased significantly in both trend and level; monthly DOT of antipseudomonal agents decreased significantly in trend. The results of these analyses of antimicrobial use are consistent with the DOT-based data based on antimicrobial use density (AUD). The total number of inpatient specimens increased significantly; the trend of multidrug-resistant Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus infections decreased, without changes in the incidence of other resistant organisms, all-cause in-hospital mortality, and length of stay. Actual and adjusted CAR purchase costs per patient-day decreased without significant changes in the actual and adjusted purchase cost per patient-day for all intravenous antimicrobials. Combining ID consultation and ASP reduced carbapenem use without negative patient outcomes. Their implementation could facilitate establishment of safe cancer treatment facilities in Japan and improve prognosis in cancer patients.
Highlights
In recent years, antimicrobial resistance (AMR) has become a global concern and the implementation of AMR-prevention measures has become an urgent requirement for medical institutions [1]
The Antimicrobial Stewardship Team (AST) provided a total of 913 instances of feedback regarding the specific broad-spectrum antimicrobials, and there were 440 infectious disease (ID) consultations
Effects of infectious disease consultation and antimicrobial stewardship program at a Japanese cancer center along with its level
Summary
Antimicrobial resistance (AMR) has become a global concern and the implementation of AMR-prevention measures has become an urgent requirement for medical institutions [1]. Especially those with hematologic malignancies or severe neutropenia and those who undergo hematopoietic stem cell transplantation, frequently develop serious infections and receive multiple rounds of antimicrobial therapy during the progression of their underlying disease [3, 4]. Patients with CRE infections are at high risk for adverse outcomes from invasive infections and can spread resistant genes within healthcare facilities. Carbapenemase-producing Enterobacteriaceae (CPE) outbreaks have been reported in cancer centers across Japan, complicating infection control and treatment of infected patients [11]. Akazawa et al [12] and Matono et al [13] reported that an ASP intervention in a tertiary care facility in Japan reduced the use of broad-spectrum antimicrobials without negative outcomes. We conducted a retrospective study to assess the impact of the introduction of the Antimicrobial Stewardship Team (AST) and infectious disease (ID) consultation in a Japanese cancer center
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