Methods: An18-item electronic survey was developed by the University of Miami and Memorial Sloan Kettering Cancer Center and administered to Infectious Disease physicians and pharmacists in US adult and pediatric SOT and HSCT centers during May 1-22, 2015.
Results: Data from 87 respondents were collected. After duplicate removal, 72 (57%) of 127 unique transplant centers in 32 states were analyzed. Sixty-one (87%) performed SOT, 58 (85%) did HSCT. Sixty (90%) had an ASP; 26 (43%) started <5 years ago. Of sites with ASPs, stewardship activities in SOT and HSCT included formulary restriction (n=46, 64%), cycling (n=3, 4%), and de-escalation (n=36, 50%). Prior authorization was done in 37 (51%) HSCT and 38 (53%) SOT; post-prescription review was done in 42 (58%) HSCT and 41 (57%) SOT. Perceived challenges limiting ASP activities in SOT and HSCT were undefined duration for certain infections (91%), delay in microbiology results (47%), antimicrobial resistant infections requiring escalation (70%), high cost antimicrobials used in SOT and HSCT (65%), and prescriber opposition (68%). Most commonly measured outcomes were antimicrobial costs (44%), rate of Clostridium difficile infections (61% HSCT, 53% SOT), antimicrobial use, e.g., days of therapy (32% HSCT, 25% SOT); 19% centers did not monitor any outcomes. Only 13% HSCT and 10% SOT had transplant specific antibiograms. If available the most useful diagnostic tests to guide therapy in SOT and HSCT patients were viral respiratory polymerase chain reaction [PCR] (100%), azole levels (97%), and bronchioalveolar lavage galactomannan (89%). Procalcitonin was perceived as not useful (n=21, 33%) or sometimes useful (n=16, 25%) for both HSCT and SOT.
Conclusion: ASP activities were done in the majority of HSCT and SOT centers that responded to the survey. Diagnostic and therapeutic uncertainty is a challenge to performing ASP activities in these patients. Collaborative research to improve our knowledge of antimicrobial stewardship in HSCT and SOT should be further explored.
S. Seo, None
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