Febrile neutropenia (FN) is a common, potentially life-threatening condition experienced most often by patients with underlying cancer and receiving chemotherapy. The University of Chicago Comer Children's Hospital utilizes ceftazidime (CTZ) as empiric coverage for FN. Our Antimicrobial Stewardship Program (ASP) primarily uses formulary restriction and prior authorization to control use. We piloted indication-based derestriction of CTZ for FN to determine whether this could be done without compromising patient care.
Ongoing retrospective data collection was completed over the same 6-month period both before and after CTZ derestriction. Data included: indication for CTZ use, number of CTZ days, time to appropriate discontinuation, positive blood cultures, patient outcomes, and time from fever to CTZ administration for inpatients.
There was no statistical difference (P > 0.05) in CTZ use, time to first dose, or rate of positive blood cultures before (Jan-June 2013) and after (Jan-June 2014) derestriction. Most positive blood cultures grew Gram-positive organisms; all Gram-negative organisms were CTZ-susceptible. Time to CTZ administration was longest for inpatients compared with clinic and emergency room (Fig 1). For inpatients, time from fever to CTZ administration was > 2h (Fig 2).
Indication-based antibiotic ordering and derestriction can be successfully implemented into an antimicrobial stewardship program with a historically restriction-based system, without significant change in the appropriate use of the derestricted agent, change in the rate of bloodstream infections, or patient outcomes. There are other factors on the inpatient unit that affect this process which must be identified to improve timely administration.
C. B. Nash,
A. H. Bartlett, None