Are hematopoietic cell transplant recipients with Gram‐negative bacteremia spending more time outpatient while on intravenous antibiotics? Addressing trends over 10 years at a single center

Immunity, Inflammation and Disease

Amanda I. Phipps *¹  Andrew Bryan²  Mohamed Sorror³  Steven Roncaioli⁴  Steven A. Pergam *⁵  Catherine Liu⁵  Ania Sweet⁵  Frank Tverdek⁵  Margaret L. Lind⁵ 

[1] Department of Epidemiology University of Washington School of Public Health Seattle Washington USA;Department of Laboratory Medicine University of Washington Seattle Washington USA;Department of Medicine University of Washington School of Medicine Seattle Washington USA;Infection Control, Department of Medicine BronxCare Health System New York New York USA;Vaccine and Infectious Disease Division Fred Hutchinson Cancer Research Center Seattle Washington USA;

关键词: ambulatory care;    antibiotic stewardship;    Gram‐negative rod bacteremia;    hematopoietic cell transplant;    outpatient care;   

DOI  :  10.1002/iid3.486

来源: DOAJ

【 摘 要 】

Abstract Introduction The increasing proportion of outpatient allogeneic hematopoietic cell transplants (HCTs) coupled with increased access of once‐daily broad‐spectrum antibiotics and evidence that outpatient antibiotic treatment may be safer and less costly than inpatient treatment, suggest that allogeneic HCT recipients with Gram‐negative rod bacteremia (GNRBs) are increasingly being treated in ambulatory care settings. Methods Using data from the first GNRB event that occurred within the first 100 days posttransplantation among allogeneic HCT recipients transplanted at a single center between 2007 and 2016, we estimated the temporal trends in GNRB incidence and treatment management of GNRBs and identified if patient or infection characteristics impacted observed trends. Results A total of 11% (238/2165) of the observed allogeneic HCT recipients experienced ≥1 GNRB with available resistance data and contributed antibiotic treatment time. Patients, on average, received 55.1% of their antibiotic treatment in an outpatient setting and we observed a significant decline in the proportion of treatment time spent outpatient (crude: −3.3% [95% confidence interval: −5.0, −1.6%]). We observed similar declines in the proportion of treatment time spent outpatient among patients with similar GNRB and pretransplant complexity factors but not among patients with similar posttransplant complications (p value: .165). Conclusion These results suggest that, despite increased availability of outpatient suitable treatment options, allogeneic HCT recipients with GNRBs received less treatment in outpatient settings. However, among patients with similar posttransplant complications, the lack of significant decline suggests that treatment location decisions remained consistent for patients with similar posttransplant complications. These findings suggest the need for additional interventions targeting outpatient antibiotic treatment among allogeneic HCT recipients with GNRBs.

【 授权许可】

Unknown