2388. Antimicrobial Stewardship Program at Hematology-Oncology and Hematopoietic Stem Cell Transplant Wards at a Children’s Hospital in Japan
Session: Oral Abstract Session: Pediatric Antimicrobial Stewardship: Controlling the Bugs and the Dollars
Saturday, October 29, 2016: 2:30 PM
Room: 275-277

 Antimicrobial stewardship program (ASP) is effective for enhancing appropriate antibiotic prescriptions. Immunocompromised children at hematology-oncology and hematopoietic stem cell transplant (HSCT) wards need to balance infection risk with optimizing antibiotics by ASP. Our aim of study is to evaluate effect and safety of ASP in immunocompromised children.


 ASP was evaluated in hematology-oncology and HSCT wards at Tokyo Metropolitan Children’s Medical Center. ASP with pre-authorization of prescriptions for carbapenems was implemented in October 2011. An institutional consensus was also reached to start with cefepime alone for febrile neutropenia, unless prescribing physician deemed other antibiotics appropriate. Pre and post interventions were compared in Phase 1 (April 2010 to September 2011) and Phase 2 (October 2011 to September 2015) for antibiotic usages, rate of susceptibility to empirical therapy in bacteremia, average length of admission, all-caused mortality and infection-related mortality at 30 days. Bacteremia was confirmed based on a positive blood culture excluding contaminations. Antibiotic usage was calculated by day of therapy (DOT) per 1,000 patient-days. Patients with terminal care from primary diseases were excluded from infection-related mortality.

Results: Antibiotic DOT for cefepime, piperacillin/tazobactam, meropenem and vancomycin were reduced significantly in Phase 2 by 17% (p=0.001), 44% (p<0.001), 55% (p=0.007) and 47% (p=0.022), respectively. Rate of susceptibility to empirical therapy in bacteremia in Phase 1 and 2 were 63.1% and 60.7%, respectively. (p=0.8) Among bacteremia, rate of susceptibility to empirical therapy in gram negative rod (GNR) in Phase 1 and 2 were 85.7% and 80.0%, respectively. (p=0.74) Extended spectrum beta-lactamase (ESBL) producing GNR was responsible for 83.3% (5/6) of missed empirical coverage for GNR. Average length of admission in Phase 1 and 2 were 73.6 days and 63.3 days, respectively. (p=0.75) All-caused mortality per 1,000 patient-days in Phase 1 and 2 were 0.074 and 0.11, respectively. (p=0.73) Infection-related mortality was not observed during study period.

Conclusion: ASP for immunocompromised children in hematology-oncology and HSCT wards could reduce both non-restricted and restricted antibiotic usages without increasing adverse outcomes.

Yuho Horikoshi, MD1, Junichi Suwa, PharB, MS2, Hiroshi Higuchi, N/A3, Takemi Murai, MD, PhD1, Yukitsugu Nakamura, MD, PhD1, Takayuki Yamanaka, MD1, Kahoru Fukuoka, MD1, Yoshiaki Cho, MD1, Hiroki Sakurai, MD1, Yuta Aizawa, MD, PhD1, Mihoko Isogai, MD1, Yuki Yuza, MD, PhD4, Takayo Shoji, MD5 and Kenta Ito, MD6, (1)Infectious Diseases, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan, (2)Pharmacy, Tokyo Metropolitan Children' s Medical Center, Tokyo, Japan, (3)Microbiology, Tokyo Metropolitan Children' s Medical Center, Tokyo, Japan, (4)Hematology-Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan, (5)Infectious Diseases, Shizuoka Children's Hospital, Shizuoka, Japan, (6)General Pediatrics, Aichi Children's Health and Medical Center, Nagoya, Japan


Y. Horikoshi, None

J. Suwa, None

H. Higuchi, None

T. Murai, None

Y. Nakamura, None

T. Yamanaka, None

K. Fukuoka, None

Y. Cho, None

H. Sakurai, None

Y. Aizawa, None

M. Isogai, None

Y. Yuza, None

T. Shoji, None

K. Ito, None

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