PMID- 36748726 OWN - NLM STAT- MEDLINE DCOM- 20230411 LR - 20230411 IS - 1399-3062 (Electronic) IS - 1398-2273 (Linking) VI - 25 IP - 2 DP - 2023 Apr TI - Density of antibiotic use and infectious complications in pediatric allogeneic hematopoietic cell transplantation. PG - e14018 LID - 10.1111/tid.14018 [doi] AB - BACKGROUND: Antibiotics, while an essential component of supportive care in allogeneic hematopoietic cell transplantation (allo-HCT), can have adverse effects and select for antibiotic resistance. Understanding of patterns of use will inform antimicrobial stewardship (AMS) interventions. METHODS: Retrospective, single-center cohort of children undergoing first allo-HCT (n = 125). Antibiotic prescription and infection data were included from the date conditioning was commenced until 30 days post allo-HCT. Antibiotic use was reported as length of therapy (LOT) (number of days a patient received an antibiotic) and days of therapy DOT (aggregating all antibiotics prescribed per day). Infections were classified as microbiologically documented infection (MDI) or clinically documented infections. RESULTS: At least one course of antibiotics was administered to 124 (99%) patients. The LOT was 636 per 1000 patient days and DOT was 959 per 1000 patient days. The median duration of cumulative antibiotic exposure per patient was 24 days (interquartile range [IQR] 20-30 days). There were 131 days of fever per 1000 patient days with patients febrile for a median of 4 days (IQR 1-7 days). Piperacillin-tazobactam was used for 116 (94%) of patients with an LOT of 532 per 1000 patient days. A total of 119 MDI episodes occurred in 74 (59%) patients, including blood stream infection in 30 (24%) and a proven/probable invasive fungal infection in 4 (3%). CONCLUSION: Pediatric HCT patients receive prolonged courses of broad-spectrum antibiotics relative to the frequency of fever and bacterial infections. This study has identified opportunities for AMS intervention to improve outcomes for our HCT patients. CI - (c) 2023 Wiley Periodicals LLC. FAU - Andrew, Eden C AU - Andrew EC AUID- ORCID: 0000-0002-2122-560X AD - Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia. FAU - Khaw, Seong Lin AU - Khaw SL AD - Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia. AD - Murdoch Children's Research Institute, Parkville, Australia. AD - Department of Paediatrics, University of Melbourne, Parkville, Australia. FAU - Hanna, Diane AU - Hanna D AD - Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia. AD - Murdoch Children's Research Institute, Parkville, Australia. AD - Department of Paediatrics, University of Melbourne, Parkville, Australia. FAU - Conyers, Rachel AU - Conyers R AD - Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia. AD - Department of Paediatrics, University of Melbourne, Parkville, Australia. AD - Cardiac Regeneration Laboratory, Murdoch Children's Research Institute, Parkville, Australia. FAU - Fleming, Jacqueline AU - Fleming J AD - Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia. FAU - Hughes, David AU - Hughes D AD - Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia. FAU - Toro, Claudia AU - Toro C AD - Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia. AD - Department of Paediatrics, University of Melbourne, Parkville, Australia. AD - Cardiac Regeneration Laboratory, Murdoch Children's Research Institute, Parkville, Australia. FAU - Wang, Stacie Shiqi AU - Wang SS AD - Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia. AD - Murdoch Children's Research Institute, Parkville, Australia. AD - Department of Paediatrics, University of Melbourne, Parkville, Australia. FAU - Weerdenburg, Heather AU - Weerdenburg H AD - Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia. AD - Murdoch Children's Research Institute, Parkville, Australia. AD - Department of Paediatrics, University of Melbourne, Parkville, Australia. FAU - Anderson, Sally AU - Anderson S AD - Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia. FAU - Cole, Theresa AU - Cole T AD - Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia. AD - Murdoch Children's Research Institute, Parkville, Australia. AD - Department of Paediatrics, University of Melbourne, Parkville, Australia. FAU - Haeusler, Gabrielle M AU - Haeusler GM AD - Murdoch Children's Research Institute, Parkville, Australia. AD - Department of Paediatrics, University of Melbourne, Parkville, Australia. AD - Department of Infectious Diseases, Royal Children's Hospital, Parkville, Australia. AD - Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia. AD - NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia. AD - Paediatric Integrated Cancer Service, Victoria, Australia. LA - eng PT - Journal Article DEP - 20230222 PL - Denmark TA - Transpl Infect Dis JT - Transplant infectious disease : an official journal of the Transplantation Society JID - 100883688 RN - 0 (Anti-Bacterial Agents) SB - IM MH - Humans MH - Child MH - Anti-Bacterial Agents/therapeutic use MH - Retrospective Studies MH - *Bacterial Infections/drug therapy/epidemiology/etiology MH - Fever/etiology MH - *Hematopoietic Stem Cell Transplantation/adverse effects OTO - NOTNLM OT - antibiotics OT - infections OT - microbiome OT - pediatrics OT - stem-cell transplantation EDAT- 2023/02/08 06:00 MHDA- 2023/04/11 06:41 CRDT- 2023/02/07 06:23 PHST- 2022/11/16 00:00 [revised] PHST- 2022/09/14 00:00 [received] PHST- 2022/12/11 00:00 [accepted] PHST- 2023/04/11 06:41 [medline] PHST- 2023/02/08 06:00 [pubmed] PHST- 2023/02/07 06:23 [entrez] AID - 10.1111/tid.14018 [doi] PST - ppublish SO - Transpl Infect Dis. 2023 Apr;25(2):e14018. doi: 10.1111/tid.14018. Epub 2023 Feb 22.