Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Oncology antimicrobial stewardship: safe intravenous-to-oral switch and antimicrobial optimisation (OASSIS) (#57)

Karen F Urbancic 1 2 3 , Adele Batrouney 1 2 , Belinda Yeo 3 4 , Niall C Tebbutt 3 4 , Olivia Smibert 2 3 , Jason A Trubiano 2 3 , Gemma K Reynolds 2 3
  1. Pharmacy, Austin Health, Heidelberg, VIC, Australia
  2. Infectious Diseases, Austin Health, Heidelberg, VIC, Australia
  3. University of Melbourne, Melbourne, VIC, Australia
  4. Medical Oncology, Austin Health, Heidelberg, VIC, Australia

Aim: 

Patients receiving cancer treatment are frequently exposed to antibiotics, increasing the risk of antibiotic resistance1. Emerging evidence supports shorter durations, and oral courses, in clinically stable patients2,3. This study aimed to evaluate the effectiveness of Infectious Diseases (ID) post-prescription review and feedback (PPRF) of antimicrobials in Oncology admitted inpatients. 

Methods 

An antimicrobial stewardship (AMS) program, involving an ID physician and pharmacist conducted twice-weekly, 15-minute PPRF with Oncology teams. Antimicrobial recommendations were made including: (i) stop; (ii) start; (iii) change (iv) dose optimisation (v) intravenous (IV)-to-oral switch; (vi) refer for a more detailed ID consult or antibiotic allergy assessment. The primary outcome of this initial implementation evaluation was recommendation acceptance within 24-hours of multidisciplinary rounds.  Secondary outcomes included antimicrobial days of therapy (DOT) per overnight bed days (OBD), and recommendation acceptance rates for febrile neutropenia (FN) infections. Prospectively collected data from PPRF were compared with retrospectively data from a 6-month pre-implementation period to evaluate changes in antimicrobials DOT/OBD. 

Results: 

Implementation began in August 2023, with 9-months of collected data available for review. A total of 298 patients and 977 prescriptions were reviewed. A median of 10 patients (IQR:8.5 – 12) and 14 orders (IQR:12, 16.5) were reviewed per meeting. 376 antimicrobial recommendations (38% of total orders) were made with overall acceptance at 87%. Most recommendations were to stop (196;52%) or switch to oral antimicrobials (68;18%), with 168 (86%) and 59 (87%) recommendations accepted respectively. 22 episodes of FN were reviewed with 21 recommendations to stop (14/21), switch (5/21), optimise (1/21), or refer (1/21) made and 100% acceptance. A reduction in broad-spectrum IV DOT/OBD, particularly piperacillin-tazobactam from an average of 9.75 to 6 DOT/OBD was observed.  

Conclusion: 

ID-led PPRF was well accepted and reduced broad spectrum antimicrobial use over the study period. Future work will evaluate patient safety outcomes.

  1. 1. Aitken, S. L, Nagel, J. L, Abbo, L., et al. Antimicrobial Stewardship in Cancer Patients: The Time is Now. J Natl Compr Canc Netw. 2019;17(7): 772-775.
  2. 2. Aguilar-Guisado M, Espigado I, Martín-Peña A, et al. Optimisation of empirical antimicrobial therapy in patients with haematological malignancies and febrile neutropenia (How Long study): an open-label, randomised, controlled phase 4 trial. The Lancet Haematology. 2017;4(12):e573-e583
  3. 3. Vidal L, Ben Dor I, Paul M et al. Oral versus intravenous antibiotic treatment for febrile neutropenia in cancer patients. Cochrane Database Syst Rev. 2013, Issue 10. Art No.: CD003992