Meropenem Use in Pediatric Oncology – Audit on Indication, Appropriateness and Consumption Comparing Patient Derived and Pharmacy Dispensing Data

2021 ◽  
Author(s):  
Svenja Ockfen ◽  
Leonie Egle ◽  
Katharina Sauter ◽  
Manfred Haber ◽  
Sören Becker ◽  
...  

ABSTRACT Background Meropenem is an important second- or third-line antibiotic in pediatric cancer patients with febrile neutropenia (FN). Concise utilization data of meropenem in this setting is limited. It remains unclear how drug dispensing data from the hospital pharmacy correlate with data derived from patients’ files. Methods Retrospective audit of meropenem-consumption in a University-affiliated pediatric oncology center in days of therapy (DOT)/100 inpatient days. The individual indication for meropenem was critically reviewed. The real consumption (in g/100 inpatient days) was compared with the drug amounts dispensed by the hospital pharmacy (in gram and in defined daily doses (DDD)/100 inpatient days). All patients receiving at least one dose of meropenem from 1st of April 2016 until the 30th of June 2018 were included. Result Of 235 consecutive patients, 45 (19%) received meropenem, comprising 57 FN events. The probability of receiving at least one dose of meropenem was significantly higher in patients with ALL, AML, NHL and certain CNS tumors. Preceding the use of meropenem, only 5% of patients were known to be colonized with multidrug-resistant Gram-negative pathogens. Meropenem was administered as first-line treatment in 26% of all meropenem cycles, in 74% of all FN events with meropenem, Piperacillin-Tazobactam was used for initial treatment. In 5 of 57 FN events (8.8%), initial blood cultures yielded a Gram-negative pathogen. Concerning definite treatment, appropriate alternatives to meropenem with a smaller spectrum of activity would have been available in 4 cases, but a de-escalation was not performed. The median length of therapy in the meropenem group was 6 days, the corresponding median for days of therapy (DOT) was 12 days. This corresponds with combination therapy in 56% of all meropenem treatments, mostly with teicoplanin. On average, drug dispensing data from the hospital pharmacy were 1.53 times higher than real use (relying on patients’ data) without a significant correlation. A higher Case-mix Index positively correlated with meropenem-consumption. Conclusion The use of meropenem should become a target of antibiotic stewardship programs in order to restrict its use to certain indications and preserve its outstanding role as second- or third-line antibiotic in this vulnerable population. Irrespective of the metrics used (g or DDD/100 inpatient days), pharmacy dispensing data do not accurately depict real patient-derived data concerning meropenem use in pediatric cancer patients.

2007 ◽  
Vol 24 (5) ◽  
pp. 255-263 ◽  
Author(s):  
Susan T. Vadaparampil ◽  
Heather Clayton ◽  
Gwendolyn P. Quinn ◽  
Lindsey M. King ◽  
Michael Nieder ◽  
...  

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2074-2074 ◽  
Author(s):  
Lisa Borretta ◽  
Tamara MacDonald ◽  
Victoria E. Price ◽  
Conrad Fernandez ◽  
Mark Bernstein ◽  
...  

Abstract OBJECTIVE: Pediatric oncology patients may require a peripherally inserted central catheter (PICC) for their therapy. Data from adult oncology studies indicate a high risk of complications associated with PICC lines. However, little data exists on the management experience of PICCs in pediatric oncology population. The aim of the present study was to document and analyze the management experience and complications with use of PICC lines in pediatric cancer patients at our center. METHODS: All pediatric cancer patients in the three Maritime Provinces of Nova Scotia, New Brunswick and Prince Edward Island are managed at the IWK health center in Halifax, Nova Scotia in a shared care model with regional hospitals. After ethics approval, all pediatric cancer patients managed at the IWK health center from January 1st 2000 through Dec 31st 2014 who received a PICC line were identified for inclusion in the study. The following databases were used to integrate data on the study patients: (i) pediatric oncology hospital database, (ii) Provincial Cancer in Young People database, (iii) Electronic medical records, (iv) Pharmacy database (v) IWK central line database and (v) Hospital Health records. Patients who received PICC line for an indication not related to their oncologic diagnosis or management were excluded from analysis. SPSS version 22 was used for statistical analysis. RESULTS: A total of 125 PICCs were placed in 102 (11.8%) of the 864 oncology patients. Of these 86 patients received 103 PICCs for oncology related indications. Fifteen (17%) patients required >1 PICC line. For the study cohort, gender ratio was 1:1. The median age at cancer diagnosis was 9.8 years (range: 0-19.3 years). Among the 86 patients who received PICC line, 37% had leukemia, 19% had lymphoma, 13% had brain tumor, 4% had sarcoma, and 28% had other diagnoses. For the first PICC, catheter duration ranged from 0 to 175 days (median 18 days) for a total of 2370 catheter days. The site of insertion was through the antecubital (16%), basilic (31%), brachial (2%), cephalic (41%), jugular (8%), saphenous (2%) veins, and was unknown in 2 patients. In 44% of patients the insertion was through the right side, 56% the left side and was unknown in 2 patients. The indication of the first PICC line included: (i) administration of chemotherapy or bone marrow transplant: 34 (39.5%), (ii) failure of a previous central venous catheter: 15 (17.4%) and (iii) supportive care such as antibiotics, parenteral nutrition or intravenous access: 37 (43.0%). The reasons for removal were as follows: (i) Complications: 24 (28.2%), (ii) elective removal: 55 (64.7%) and (iii) other reasons: 6 (7.1%). Among the 55 PICCs removed electively, 12 (14.0%) were removed at the completion of cancer treatment, 23 (26.7%) at the completion of supportive care, and 20 (23.3%) were replaced with another type of central venous catheter. Among the 24 PICCs removed due to complications, 6 were removed due to infection, 15 due to mechanical complications and 3 due to thrombosis. CONCLUSION: We found that PICC lines are frequently used in pediatric cancer patients for a variety of indications. Seventeen percent of the patients needed >1 PICC line. Further, close to 1/3rd of the patients experienced a complication related to their PICC line. Our experience highlights the need to conduct further studies addressing (i) indications of PICC line insertion in pediatric oncology (ii) determination of causes of PICC line related complications to help guide PICC line indications. Identifying patients at high risk of PICC line related complications will aid judicious choice of PICC line in pediatric cancer patients. Disclosures No relevant conflicts of interest to declare.


2013 ◽  
Vol 34 (3) ◽  
pp. 315-320 ◽  
Author(s):  
Aditya H. Gaur ◽  
David G. Bundy ◽  
Cuilan Gao ◽  
Eric J. Werner ◽  
Amy L. Billett ◽  
...  

Across 36 US pediatric oncology centers, 576 central line-associated bloodstream infections (CLABSIs) were reported over a 21-month period. Most infections occurred in those with leukemia and/or profound neutropenia. The contribution of viridans streptococci infections was striking. Study findings depict the contemporary epidemiology of CLABSIs in hospitalized pediatric cancer patients.


2021 ◽  
Author(s):  
Nurul Huda Razalli ◽  
Hamidah Alias ◽  
Mohd Hafizuddin Mohammad ◽  
Nur Ruzaireena Rahim ◽  
Nur Qharena Alwani Zulkipli

Abstract Background A good audio-visual educational material for caregivers on nutrition management of pediatric oncology patients can improve treatment effectiveness, recovery rate, and nutritional status of patients. This study aimed to develop and evaluate a series of video-based educational materials for nutritional management of pediatric oncology patients among healthcare professionals and caregivers.Methods The development of the video series began with subtopic selection and content refinement based on a printed booklet project previously published by the groups of five experts in dietetics and oncology medicine and five caregivers of pediatric cancer patients. 10 healthcare professionals (medical doctors and dietitians with over 5 years of working experience) and 15 caregivers then evaluated the video series for acceptability and relevance using the Malay version of the Patient Education Materials Assessment Tools for Audio-Visual materials (PEMAT-AV). Sets of understandability and actionability statements were given a score of 0 (disagree) or 1 (agree), and the overall percentage was calculated.ResultFour main topics were selected from the booklet and adopted into 5 video series ranging from 3 to 8 minutes in length developed in the Malay language entitled (i) Introduction to Cancer and the Treatment, (ii) The Side Effects of Cancer Treatment and Management (Part 1), (iii) The Side Effects of Cancer Treatment and Management (Part 2), (iv) Nutrition Management in Children with Cancer, and (v) You Ask, We Answer. The average understandability and actionability scores rated by the healthcare professionals were 98.6%% and 98.7%respectively. Whereas the caregivers’ average score for understandability was 99.5% and 99.6% for actionability.ConclusionsThe findings revealed that a high-quality video series was successfully developed and rated as highly understandable and actionable by both healthcare professionals and caregivers. This reflects positive acceptance and relevance of the nutritional management educational videos by both groups who manage and care for pediatric cancer patients. Trial RegistrationCentre for Research and Instrumentation Management, Research Ethics Committee of The National University of Malaysia; Ref. No. UKM/PPI/111/8/JEP-2021-266


2013 ◽  
Author(s):  
Fransisca M. Sidabutar ◽  
Anggie Regia Anandari ◽  
Ingrid Karli ◽  
Yusnita Katagori ◽  
Henny E. Wirawan

2007 ◽  
Author(s):  
Margaret M. Mannix ◽  
Nicole Furnari ◽  
Adam Rudolph ◽  
Karen M. Moody

2001 ◽  
Author(s):  
Barbara O. Rothbaum ◽  
Larry F. Hodges ◽  
Jonathan Gershon ◽  
Michael Briones ◽  
Melissa Pickering

2012 ◽  
Vol 82 ◽  
pp. S17 ◽  
Author(s):  
S. Al Jaouni ◽  
A. Hussein ◽  
M. Al Muhayawi ◽  
K. Ibrahim ◽  
I. Elfiki

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