Please use this identifier to cite or link to this item: doi:10.22028/D291-39744
Title: Antimicrobial use in pediatric oncology and hematology in Germany and Austria, 2020/2021: a cross-sectional, multi-center point-prevalence study with a multi-step qualitative adjudication process
Author(s): Papan, Cihan
Reifenrath, Katharina
Last, Katharina
Attarbaschi, Andishe
Graf, Norbert
Groll, Andreas H.
Hübner, Johannes
Laws, Hans-Jürgen
Lehrnbecher, Thomas
Liese, Johannes G.
Martin, Luise
Tenenbaum, Tobias
Vieth, Simon
von Both, Ulrich
Wagenpfeil, Gudrun
Weichert, Stefan
Hufnagel, Markus
Simon, Arne
Baier, Jan
Balzer, Stefan
Behr, Ümmügül
Bernbeck, Benedikt
Beutel, Karin
Blattmann, Claudia
Bochennek, Konrad
Cario, Holger
Eggert, Angelika
Ehlert, Karoline
Göpner, Simone
Kontny, Udo
Körholz, Dieter
Kramm, Christof
Lauten, Melchior
Lessel, Lienhard
Linderkamp, Christin
Lobitz, Stephan
Maas, Volker
Misgeld, Rainer
Mücke, Urs
Neubert, Jennifer
Nonnenmacher, Lisa
Queudeville, Manon
Redlich, Antje
Rodehüser, Martina
Schober, Sarah
Siepermann, Meinolf
Simon, Thorsten
Souliman, Hadi
Stiefel, Martina
Wiegering, Verena
Winkler, Beate
Language: English
Title: The Lancet Regional Health : Europe
Volume: 28
Publisher/Platform: Elsevier
Year of Publication: 2023
Free key words: Antimicrobial resistance
Antimicrobial stewardship
Cancer
Expert panel
Pediatric hematology
Pediatric oncology
Point-prevalence survey
DDC notations: 610 Medicine and health
Publikation type: Journal Article
Abstract: Background Due to the high risk of severe infection among pediatric hematology and oncology patients, antimicrobial use is particularly high. With our study, we quantitatively and qualitatively evaluated, based on institutional standards and national guidelines, antimicrobial usage by employing a point-prevalence survey with a multi-step, expert panel approach. We analyzed reasons for inappropriate antimicrobial usage. Methods This cross-sectional study was conducted at 30 pediatric hematology and oncology centers in 2020 and 2021. Centers affiliated to the German Society for Pediatric Oncology and Hematology were invited to join, and an existing institutional standard was a prerequisite to participate. We included hematologic/oncologic inpatients under 19 years old, who had a systemic antimicrobial treatment on the day of the point prevalence survey. In addition to a one-day, point-prevalence survey, external experts individually assessed the appropriateness of each therapy. This step was followed by an expert panel adjudication based upon the participating centers’ institutional standards, as well as upon national guidelines. We analyzed antimicrobial prevalence rate, along with the rate of appropriate, inappropriate, and indeterminate antimicrobial therapies with regard to institutional and national guidelines. We compared the results of academic and non-academic centers, and performed a multinomial logistic regression using center- and patient-related data to identify variables that predict inappropriate therapy. Findings At the time of the study, a total of 342 patients were hospitalized at 30 hospitals, of whom 320 were included for the calculation of the antimicrobial prevalence rate. The overall antimicrobial prevalence rate was 44.4% (142/320; range 11.1–78.6%) with a median antimicrobial prevalence rate per center of 44.5% (95% confidence interval [CI] 35.9–49.9). Antimicrobial prevalence rate was significantly higher (p < 0.001) at academic centers (median 50.0%; 95% CI 41.2–55.2) compared to non-academic centers (median 20.0%; 95% CI 11.0–32.4). After expert panel adjudication, 33.8% (48/142) of all therapies were labelled inappropriate based upon institutional standards, with a higher rate (47.9% [68/142]) when national guidelines were taken into consideration. The most frequent reasons for inappropriate therapy were incorrect dosage (26.2% [37/141]) and (de-)escalation/spectrum-related errors (20.6% [29/141]). Multinomial, logistic regression yielded the number of antimicrobial drugs (odds ratio, OR, 3.13, 95% CI 1.76–5.54, p < 0.001), the diagnosis febrile neutropenia (OR 0.18, 95% CI 0.06–0.51, p = 0.0015), and an existing pediatric antimicrobial stewardship program (OR 0.35, 95% CI 0.15–0.84, p = 0.019) as predictors of inappropriate therapy. Our analysis revealed no evidence of a difference between academic and non-academic centers regarding appropriate usage. Interpretation Our study revealed there to be high levels of antimicrobial usage at German and Austrian pediatric oncology and hematology centers with a significant higher number at academic centers. Incorrect dosing was shown to be the most frequent reason for inappropriate usage. Diagnosis of febrile neutropenia and antimicrobial stewardship programs were associated with a lower likelihood of inappropriate therapy. These findings suggest the importance of febrile neutropenia guidelines and guidelines compliance, as well as the need for regular antibiotic stewardship counselling at pediatric oncology and hematology centers. Funding European Society of Clinical Microbiology and Infectious Diseases, Deutsche Gesellschaft für Pädiatrische Infektiologie, Deutsche Gesellschaft für Krankenhaushygiene, Stiftung Kreissparkasse Saarbrücken.
DOI of the first publication: 10.1016/j.lanepe.2023.100599
URL of the first publication: https://www.sciencedirect.com/science/article/pii/S2666776223000170
Link to this record: urn:nbn:de:bsz:291--ds-397441
hdl:20.500.11880/35811
http://dx.doi.org/10.22028/D291-39744
ISSN: 2666-7762
Date of registration: 11-May-2023
Description of the related object: Appendix A. Supplementary data
Related object: https://ars.els-cdn.com/content/image/1-s2.0-S2666776223000170-mmc1.docx
Faculty: M - Medizinische Fakultät
Department: M - Infektionsmedizin
M - Medizinische Biometrie, Epidemiologie und medizinische Informatik
M - Pädiatrie
Professorship: M - Prof. Dr. Sören Becker
M - Prof. Dr. Norbert Graf
M - Prof. Dr. Stefan Wagenpfeil
Collections:SciDok - Der Wissenschaftsserver der Universität des Saarlandes

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