AI Article Synopsis
- Febrile neutropenia (FN) is a major cause of mortality in children with cancer, partly due to the risk of antibiotic resistance from prolonged antibiotic use.
- A study conducted between 2011 and 2014 assessed the impact of antibiotic cycling on 126 pediatric cancer patients undergoing treatment.
- Results showed a significant reduction in the detection of antibiotic-resistant bacteria in blood and stool cultures after implementing antibiotic cycling.
Article Abstract
Background: Febrile neutropenia (FN) is the main treatment-related cause of mortality among children with cancer, as the prolonged use of broad-spectrum antibiotics can lead to antibiotic resistance in these patients. Antibiotic cycling has been reported to limit the emergence of antibiotic-resistant bacteria among adult patients. However, no studies have evaluated pediatric patients with FN.
Methods: Between September 2011 and February 2014, 126 pediatric cancer patients were admitted to our center for chemotherapy and/or hematopoietic stem cell transplantation and were included in this study. Retrospective and prospective data collection were performed before and after antibiotic cycling, respectively. Between September 2011 and November 2012 (before antibiotic cycling was implemented), intravenous cefpirome was used as the empirical therapy for FN. Between December 2012 and February 2014 (after antibiotic cycling was implemented), the monthly antibiotic cycling involved intravenous piperacillin-tazobactam (PIPC/TAZ), intravenous meropenem or ciprofloxacin (CPFX), and intravenous cefepime in that order. For children aged ≥13 years, the monthly cycling involved intravenous PIPC/TAZ, and CPFX was administered.
Results: The detection rates for extended-spectrum β-lactamase producers in blood and stool culture samples decreased significantly after the implementation of antibiotic cycling (0.33/1000 patient-days vs 0/1000 patient-days, p = 0.03; 1.00/1000 patient-days vs 0/1000 patient-days, p < 0.01; respectively).
Conclusion: Antibiotic cycling was associated with a decreased emergence of multidrug-resistant microbes.
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| http://dx.doi.org/10.1016/j.jiac.2017.03.020 | DOI Listing |
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