Evaluation of an empiric antibiotic regimen in pediatric oncology patients presenting with fever does not reveal the emergence of antibiotic resistance over a 12-year period

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.

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194. Antibiotic-resistant bloodstream infections in pediatric oncology patients on levofloxacin prophylaxis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.238 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S102-S102

Author(s):

Sunita Sridhar ◽

Anurag K Agrawal ◽

Lauren Ferrerosa ◽

Brian Lee ◽

Prachi Singh

Keyword(s):

Antibiotic Resistance ◽

Pediatric Oncology ◽

Case Series ◽

Bloodstream Infections ◽

Published Data ◽

Close Monitoring ◽

Oncology Patients ◽

Antibiotic Resistant ◽

Viridans Streptococcus ◽

Levofloxacin Prophylaxis

Abstract Background Levofloxacin prophylaxis in pediatric oncology patients with chemotherapy-induced severe prolonged neutropenia has been shown to reduce risk for febrile neutropenia and systemic infections. With increased use of prophylaxis there is concern for development of antibiotic-resistant infections. We analyzed bloodstream infections (BSI) in pediatric oncology patients exposed to levofloxacin prophylaxis during prolonged severe neutropenic episodes to determine the rate of antibiotic resistance Methods We performed a retrospective chart review of pediatric oncology patients who received levofloxacin prophylaxis between January 2015 – December 2019. Patients were placed on levofloxacin prophylaxis based on institutional guidelines for patients at risk for severe prolonged neutropenia (i.e., absolute neutrophil count [ANC] < 500 cells/µL for >7 days). Demographic information, start and end dates for levofloxacin prophylaxis, and all BSI episodes within 2 months after exposure to the fluoroquinolone were collected Results Thirty-five patients were identified who received levofloxacin prophylaxis. There were 32 BSI in 12 patients. Twenty-five BSI involved gram-positive organisms (GP), including nine (36%) due to coagulase negative Staphylococcus and seven (28%) due to viridans Streptococcus. Seven BSI episodes involved gram-negative (GN) organisms with 4 (57%) from E.coli. Resistance to fluroquinolones was noted in 42% and 48% of BSI from GN and GP organisms respectively. The vast majority (85%) of viridans Streptococcus isolates were resistant to levofloxacin. In contrast, 8% of viridans Streptococcus isolates were resistant to fluoroquinolones from the same time frame per our hospital antibiogram. Conclusion In this recent cohort of pediatric oncology patients with BSI after exposure to levofloxacin prophylaxis, there was a high percentage infected with fluoroquinolone-resistant organisms.This contrasts with some of the earlier published data from adults which reported low rate of fluoroquinolone resistance. This case series highlights the need for close monitoring for development of antibiotic resistance as utilization of prophylactic levofloxacin increases in pediatric oncology patients. Disclosures All Authors: No reported disclosures

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