Thread by @AdrienContejean

📢 Our new study "Antimicrobial stewardship in high-risk febrile neutropenia patients." is now out in #ARIC !💥

Find our open access paper here: rdcu.be/cJ5un

And some data bellow ⬇️ (1/10)

📄 In this before/after study, we evaluated the impact of an AMS intervention in patients with high-risk febrile neutropenia. The guidelines were based on a discontinuation/de-escalation strategy based on ECIL4 recommendations. (2/10)

📌Carbapenems and glycopeptides consumption decreased by ⬇️72% (B) and ⬇️85% (F), respectively.
(3/10)

📌Our composite endpoint “ICU transfer for more than 24h or death” decreased significantly after implementation of the guidelines (8.3% vs 17.9% before implementation).
(4/10)

📌In a multivariate logistic regression analysis, age > 60y, Charlson comorbidity index >3 and fever during stay were associated with a worse outcome regarding the composite endpoint, whereas post-intervention period was independently associated with a better outcome. (5/10)

📌Interestingly, we noted a trend towards lower rates of both ESBL-PE and meropenem-resistant Pseudomonas aeruginosa invasive strains in the post intervention period (NS). (6/10)

Implementation of a de-escalation and discontinuation strategy based on ECIL4 guidelines for patients with high-risk FN in our center was feasible, safe, and led to a significant decrease in glycopeptide and carbapenem consumption at the scale of an intensive hematology unit. (7)

Our results are consistent with recently published data from other centers:
👉academic.oup.com/ofid/article/9…
👉jnccn.org/configurable/c…

In our study, the overall standard of care was impacted, with significantly less ICU transfers after the intervention. Also, it was accompanied by a trend towards fewer meropenem-resistant P aeruginosa infections, although larger studies are warranted to confirm this observation.

A multidisciplinary approach, with endorsement of guidelines by both hematology and AMS teams, and close collaboration for patient care appear to be key factors in the success of such programs in this specific population. (10/10)

.@KerneisSolen @RuiBatista94270 @Info_ATBVAC @AIHemato @ABsteward @Willeeuhmm @DrToddLee @IDstewardship @moore_wjustin @SIDPharm @Berninini @OncIDPharmd @ASP_MirandaS

*below…