Itoh Naoya, Akazawa-Kai Nana, Yamaguchi Makoto, Kawabata Takanori
Division of Infectious Diseases, Aichi Cancer Center Hospital, Aichi, Japan.
Department of Infectious Diseases, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan.
Open Forum Infect Dis. 2024 Nov 13;11(12):ofae678. doi: 10.1093/ofid/ofae678. eCollection 2024 Dec.
Patients with cancer are particularly susceptible to developing drug-resistant organisms due to the high frequency of infections during cancer treatment and the use of broad-spectrum antimicrobial agents. Therefore, patients with cancer are ideal candidates for an antimicrobial stewardship program (ASP); however, no established ASPs specifically target these patients. In this study, we evaluated the effect of a 46-month ASP intervention and infectious diseases consultation using a unique antimicrobial quality measure.
Our single-center, retrospective, observational study was conducted from 1 April 2018 to 31 January 2024 and evaluated 2 phases: preintervention (antimicrobial notification by the infection control team) and postintervention (implementation of ASP and establishment of the infectious diseases consultation service).
The days of therapy (DOT) for 3 intravenous carbapenems significantly decreased, and the DOT of narrow-spectrum antimicrobials significantly increased after the intervention. A significant reduction was observed in the length of hospital stay, with no change in the incidence of hospital-acquired resistant microorganisms. All-cause in-hospital mortality rates and the 30-day mortality rate among patients with bacteremia episodes were numerically reduced, although not significantly, compared to the preintervention period. The rate of appropriate use of antimicrobial agents increased significantly during the late postintervention period (1 April 2021 to 31 January 2024).
Our intervention was associated with the promotion of appropriate use of antimicrobial agents and a reduction in the length of hospital stay. These findings can help establish safer cancer treatments and improve patient prognosis.
癌症患者由于在癌症治疗期间感染频率高以及使用广谱抗菌药物，特别容易感染耐药菌。因此，癌症患者是抗菌药物管理计划（ASP）的理想对象；然而，目前尚无专门针对这些患者的成熟ASP。在本研究中，我们使用一种独特的抗菌质量指标评估了为期46个月的ASP干预和传染病会诊的效果。
我们的单中心回顾性观察研究于2018年4月1日至2024年1月31日进行，评估了两个阶段：干预前（感染控制团队进行抗菌药物通报）和干预后（实施ASP并建立传染病会诊服务）。
干预后，3种静脉用碳青霉烯类药物的治疗天数（DOT）显著减少，窄谱抗菌药物的DOT显著增加。住院时间显著缩短，医院获得性耐药微生物的发生率无变化。与干预前期相比，菌血症发作患者的全因住院死亡率和30天死亡率在数值上有所降低，但未达到显著水平。在干预后期（2021年4月1日至2024年1月31日），抗菌药物的合理使用率显著提高。
我们的干预措施有助于促进抗菌药物的合理使用并缩短住院时间。这些发现有助于建立更安全的癌症治疗方法并改善患者预后。
