Many patients with cancer were observed to have a potential antibiotic-related adverse event, indicating antibiotic stewardship and oncology practice collaboration may be needed to optimize patient care. These findings were published in the Journal of Hematology Oncology Pharmacy.
Antimicrobial stewardship programs were established in an effort to reduce inappropriate use, resistance, and patient harm related to antibiotic therapy and tend to focus on the general population. This study aimed at understanding the potential role for such a program among the immunocompromised population, such as patients with cancer. This retrospective, cross-sectional study was conducted at the Henry Ford Hospital between 2018 and 2019. The antimicrobial program at that institution is comprised of 1 full time-equivalent pharmacist supported by a faculty member and pharmacy trainees.
A total of 200 patients with cancer who received antimicrobial agents during their hospital stay were assessed for antibiotic selection and outcomes.
The patient population comprised 55% women, median age 65 years (interquartile range [IQR], 58 to 74), 53% were White, 24% had an antibiotic allergy, 70.5% had solid tumors, and 45.5% received chemotherapy in the previous 30 days.
Patients most frequently were given antibiotics due to pulmonary infections (38.5%), intra-abdominal infections (17%), and urinary tract infections (15.5%). Most received intravenous antibiotics (93.5%) for a median 7 days (IQR, 5 to 11).
There was an opportunity for antibiotic stewardship intervention in 42% of the total study population. Stewardship was indicated due to institutional guideline-discordant antibiotic use (73.8%), excessive antibiotic spectrum (91.9%), and no de-escalation (34.5%).
Potential antibiotic-related adverse events occurred in 41.5% of patients. Those who received Pseudomonas coverage antibiotics were more likely to experience an adverse event (odds ratio [OR], 3.08; 95% CI, 1.55-6.109; P <.001).
This study was limited by its single-center, retrospective design.
The researchers concluded that opportunities for antimicrobial stewardship interventions exist in the oncology setting. Additional prospective study is needed to assess the efficacy of an oncology practice collaboration program.
Medler C, Kenney R, Davis S. Evaluating antibiotic use and opportunities for intervention in patients with cancer. J Hematol Oncol Pharm. 2021;11(6):312-317.