scholarly journals Empiric Vancomycin Use in Febrile Neutropenic Oncology Patients

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Jessica Libuit ◽  
Andrew Whitman ◽  
Rebecca Wolfe ◽  
Casey S. Washington
Keyword(s):  
Antibiotic Resistance ◽  
Febrile Neutropenia ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Empiric Therapy ◽  
Vancomycin Therapy ◽  
Oncology Patients ◽  
Teaching Institution ◽  
Large Community ◽  
Community Teaching

Abstract Vancomycin is commonly added as empiric therapy for febrile neutropenia. A retrospective chart review was conducted at a large community teaching institution to evaluate vancomycin use in oncology patients. The results revealed that a majority of empiric vancomycin therapy was inappropriate, raising concern for antibiotic resistance and prompting opportunities for improvement.

scholarly journals 2532. Identifying Educational Needs and Improving Provider Knowledge Regarding the Management of Febrile Neutropenia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S880-S880
Author(s):  
Amy Chang ◽  
Stan Deresinski ◽  
Aruna Subramanian ◽  
Bruno Medeiros ◽  
Emily Mui, PharmD ◽  
...  
Keyword(s):  
Medical Students ◽  
Febrile Neutropenia ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Empiric Therapy ◽  
Myelogenous Leukemia ◽  
Front Line ◽  
National Guidelines ◽  
Gram Positive ◽  
The Impact

Abstract Background In a retrospective chart review of 211 first episodes of febrile neutropenia (FN) in in-patients with acute myelogenous leukemia evaluating rates of appropriate vs. inappropriate management, we identified frequent noncompliance with national guidelines for the management of FN. We utilized these data to develop an educational intervention targeting front-line providers. Methods Based on findings from our chart review, we developed and implemented an interactive, case-based didactic session for advanced practice providers (APPs) and medical students/residents rotating on hematology, targeting inappropriate antibiotic use. Pretest questions were embedded into the lecture, preceding content related to each learning objective. Lecture material included content from national guidelines, literature addressing misconceptions (e.g., vancomycin usage for persistent fever), and data from our institutional antibiogram (Figure 1). A post-test was given directly after the lecture to evaluate knowledge gained. Results Five inappropriate behaviors were identified (Figure 2): (1) changing empiric therapy despite clinical stability, (2) misunderstanding piperacillin/tazobactam’s spectrum of activity, (3) inappropriate initiation of antibiotics active against resistant Gram-positive organisms; (4) failure to de-escalate therapy at 72 hours and (5) failure to add Gram-positive coverage when using aztreonam. Lectures were provided to 13 APPs and 17 medical students/residents over 6 sessions. An improvement in knowledge was noted for most learning objectives except for the third, for which misconceptions remained, especially regarding need for vancomycin in the setting of mucositis (Figures 3 and 4). Higher baseline knowledge was noted for medical students/residents than APPs. 93% of learners rated the lecture very/extremely helpful. Learners recommended future content focus on antifungal therapy. Conclusion We utilized local practice data to develop educational content for front-line providers. We will convert this lecture into a video-format to be incorporated into hematology rotations to reinforce key concepts. A prospective cohort study to evaluate the impact on prescribing behavior is underway. Disclosures All authors: No reported disclosures.

Use of Pamidronate for Hypercalcemia of Malignancy in Renal Dysfunction

2019 ◽  
pp. 089719001988316 ◽  
Author(s):  
Sarah J. Norman ◽  
David J. Reeves ◽  
Lindsay M. Saum
Keyword(s):  
Renal Function ◽  
Renal Dysfunction ◽  
Chart Review ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Primary Objective ◽  
Limited Impact ◽  
Hypercalcemia Of Malignancy ◽  
Baseline Renal Function ◽  
Community Teaching

Background: Few studies have been conducted investigating the use of bisphosphonates in hypercalcemia of malignancy (HCM) in the setting of renal dysfunction. Objective: The primary objective was to compare the incidence of acute kidney injury (AKI) within 7 days of receiving pamidronate for the treatment of HCM with pre-existing renal dysfunction versus normal renal function at the time of pamidronate administration. The secondary objectives explored the effects of pamidronate doses and infusion rates on the safety and efficacy in those with pre-existing renal dysfunction for the treatment of HCM. Methods: A retrospective chart review was conducted on patients who received pamidronate for the treatment of HCM at a community teaching hospital in Indianapolis, Indiana, from January 1, 2013, to May 31, 2017. Results: A total of 141 pamidronate administrations were included (116 patients had normal baseline renal function, and 25 patients had pre-existing renal dysfunction before pamidronate administration for the treatment of HCM). Two (8%) patients developed AKI in the pre-existing renal dysfunction group, compared with 4 (3.4%) patients in those without pre-existing renal dysfunction ( P = .288). For those with pre-existing renal dysfunction, the incidence of AKI did not differ based on the dosage of pamidronate given ( P = .762) or infusion rates ( P = .373). Conclusion: Pamidronate appears to have limited impact on renal function at doses up to 90 mg in the setting of pre-existing renal dysfunction for the treatment of HCM.

scholarly journals Limiting Vancomycin Exposure in Pediatric Oncology Patients With Febrile Neutropenia May Be Associated With Decreased Vancomycin-Resistant Enterococcus Incidence

2019 ◽  
Vol 9 (4) ◽  
pp. 428-436 ◽  
Author(s):  
Manjiree V Karandikar ◽  
Carly E Milliren ◽  
Robin Zaboulian ◽  
Poornima Peiris ◽  
Tanvi Sharma ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
High Risk ◽  
Febrile Neutropenia ◽  
Pediatric Oncology ◽  
Antibiotic Use ◽  
Vancomycin Resistant Enterococcus ◽  
Post Intervention ◽  
Oncology Patients ◽  
Vancomycin Resistant ◽  
The Impact

Abstract Background Limited data exists regarding the effects of empiric antibiotic use in pediatric oncology patients with febrile neutropenia (FN) on the development of antibiotic resistance. We evaluated the impact of a change in our empiric FN guideline limiting vancomycin exposure on the development of vancomycin-resistant Enterococcus in pediatric oncology patients. Methods Retrospective, quasi-experimental, single-center study using interrupted timeseries analysis in oncology patients aged ≤18 years with at least 1 admission for FN between 2009 and 2015. Risk strata incorporated diagnosis, chemotherapy phase, Down syndrome, septic shock, and typhlitis. Microbiologic data and inpatient antibiotic use were obtained by chart review. Segmented Poisson regression was used to compare VRE incidence and antibiotic days of therapy (DOT) before and after the intervention. Results We identified 285 patients with 697 FN episodes pre-intervention and 309 patients with 691 FN episodes postintervention. The proportion of high-risk episodes was similar in both periods (49% vs 48%). Empiric vancomycin DOT/1000 FN days decreased from 315 pre-intervention to 164 post-intervention (P < .01) in high-risk episodes and from 199 to 115 in standard risk episodes (P < .01). Incidence of VRE/1000 patient-days decreased significantly from 2.53 pre-intervention to 0.90 post-intervention (incidence rate ratio, 0.14; 95% confidence interval, 0.04–0.47; P = .002). Conclusions A FN guideline limiting empiric vancomycin exposure was associated with a decreased incidence of VRE among pediatric oncology patients. Antimicrobial stewardship interventions are feasible in immunocompromised patients and can impact antibiotic resistance.

scholarly journals Meropenem Versus Piperacillin-Tazobactam as Empiric Therapy for Febrile Neutropenia in Pediatric Oncology Patients

2014 ◽  
Vol 15 (11) ◽  
pp. 4549-4553 ◽  
Author(s):  
Gulay Sezgin ◽  
Can Acipayam ◽  
Ayse Ozkan ◽  
Ibrahim Bayram ◽  
Atila Tanyeli
Keyword(s):  
Febrile Neutropenia ◽  
Pediatric Oncology ◽  
Empiric Therapy ◽  
Oncology Patients

scholarly journals Effect of Pharmacists’ Interventions on the Appropriateness of Empiric Vancomycin Therapy in Oncology Patients with Febrile Neutropenia

2019 ◽  
Vol 26 (2) ◽  
pp. 53-59
Author(s):  
Nour Baghdady ◽  
Daniel Voit ◽  
Anne M. McDonell ◽  
David W. Kubiak
Keyword(s):  
Febrile Neutropenia ◽  
Phase I ◽  
Phase Ii ◽  
Vancomycin Therapy ◽  
Gram Positive ◽  
Oncology Patients ◽  
Two Phase ◽  
Pharmacy Intervention ◽  
Phase Study ◽  
Objective Evidence

The purpose of this observational study is to evaluate the effect of an active pharmacy intervention to facilitate timely discontinuation of empiric vancomycin therapy in oncology patients with febrile neutropenia who lack objective evidence of a Gram-positive infection. This was a two-phase study. Vancomycin use was evaluated retrospectively on all oncology patients with febrile neutropenia over four weeks (phase I). In a parallel four weeks a year later, vancomycin use in this patient population was evaluated prospectively (phase II). In the absence of evidence of Gram-positive infection after 72 hours of treatment initiation, the team was contacted by a pharmacist to encourage discontinuation. Usage was compared between both phases. Forty-three patients in phase I and 25 patients in phase II were treated with vancomycin with no evidence for Gram-positive infections. Pharmacists’ interventions were documented on 18 patients in phase II. Of these, 56% of interventions to discontinue vancomycin were accepted, but only 33.3% of patients had treatment stopped within 72 hours of initiation. Although not significant, a trend in more appropriate use of vancomycin in oncology patients with febrile neutropenia was observed. Pharmacist’s interventions might have played a role in this observation.

scholarly journals Mortality in a Heterogeneous Population of Low-Risk Febrile Neutropenic Patients Treated Initially with Cefazolin and Tobramycin

2009 ◽  
Vol 20 (4) ◽  
pp. e145-e152 ◽  
Author(s):  
Francesca Le Piane ◽  
Sandra AN Walker ◽  
Scott E Walker ◽  
Nina Lathia ◽  
Carlo De Angelis ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Health Sciences ◽  
Primary Objective ◽  
Prospective Data ◽  
Sunnybrook Health ◽  
The Past ◽  
All Cause Mortality ◽  
Neutropenic Patients

BACKGROUND: At Sunnybrook Health Sciences Centre in Toronto, Ontario, the recommended empiric regimen for febrile neutropenia has been cefazolin and tobramycin for at least 25 years. However, we had no objective data to reassure us that patient mortality had not increased over the past five years.METHODS: A retrospective chart review of 48 episodes occurring in 44 patients admitted for the treatment of febrile neutropenia secondary to chemotherapy in 2002, and initially managed with cefazolin and tobramycin was conducted. Prospective data from 48 episodes in 2007 had previously been collected. Patients who developed febrile neutropenia while in hospital were excluded. The primary objective of the present study was to compare the all-cause mortality in 2007 with that from 2002.RESULTS: There were no statistically significant differences between the groups (P>0.05). All-cause mortality in 2007 was 8.3% (four of 48) compared with 10.4% (five of 48) in 2002 (P=1). All deaths occurred in patients considered to be at high risk according to the Talcott score.CONCLUSION: Mortality has not increased in the past five years with the use of empiric cefazolin and tobramycin for the treatment of patients admitted with febrile neutropenia at Sunnybrook Health Sciences Centre. Rates are comparable with those reported in the literature for similar patients. The results of the present study provide reassurance that the regimen continues to be effective for lower-risk febrile neutropenic patients.

scholarly journals 227. Evaluation of Empiric Vancomycin Utilization at 72 Hours Post Admission: is De-escalation of Vancomycin Appropriate?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S114-S115
Author(s):  
Mandana Naderi ◽  
Kimberly Welker ◽  
Tina Pourshams-Manzouri ◽  
Vanthida Huang ◽  
Amy Buros
Keyword(s):  
Chart Review ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
White Blood Cells ◽  
Positive Culture ◽  
Retrospective Chart Review ◽  
P Value ◽  
Vancomycin Therapy ◽  
Clinical Criteria ◽  
Time Out ◽  
Days Of Therapy

Abstract Background At both of our institutions in 2018, the average vancomycin days of therapy per 1,000 patient days was 112. The purpose of this study was to examine a 72-hour time-out as an effective de-escalation tool by evaluating the indication and clinical appropriateness of the continuation of empiric vancomycin therapy. Methods A retrospective chart review was performed from January 2018 to October 2018 at two community hospitals. Patients > 18 years who received at least 3 days of empiric vancomycin therapy were included. Patients were excluded if immunocompromised, pregnant, on hemodialysis, received vancomycin for surgical prophylaxis, or expired within 72 hours of vancomycin initiation. Criteria for appropriate continuation of vancomycin at 3 days: positive culture for methicillin-resistant Staphylococcus aureus (MRSA), presence of infection with or without defined sources with systemic signs of infection (i.e. white blood cells >12,000 cells/L or < 5,000 cells/L and/or elevated temperature ≥ 37.5°C), or pending wound/sputum cultures after vancomycin initiation. Results A total of 160 adult patients initiated on vancomycin were analyzed; 118 of 160 (74%) met appropriate criteria. The most common indications for vancomycin were: skin and soft tissue infections (SSTI) 82 patients (51%); pneumonia 37 patients (23%); and positive blood culture 20 patients (13%). Risk factors for MRSA were similar between both groups. Forty-four (28%) patients had cultures pending and 23 patients (14%) had a known non-MRSA pathogen at time of assessment. American Indian race (OR 3.01 (1.21, 7.53) p-value= 0.0174) and SSTI indication (OR 2.87 (1.24, 6.80) p-value= 0.0147) were associated with not meeting appropriate criteria. Conclusion Approximately 25% of patients receiving empiric vancomycin therapy did not meet clinical criteria for continuation beyond 72 hours. The indication most commonly associated with continued vancomycin utilization was SSTI. These results identified indications in which empiric vancomycin prescribing can be optimized, and a 72-hour antibiotic time-out may be warranted as a stewardship intervention. Timely culture obtainment and intervention when another pathogen is identified are possible strategies to ensure success of 72-hour time-out. Disclosures All Authors: No reported disclosures

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