Common goals, barriers to antimicrobial stewardship among pediatric cancer patients identified

MEMPHIS, Tenn. — Doctors and pharmacists involved in antimicrobial stewardship programs among pediatric cancer patients identified shared program-related goals as well as program-related barriers, according to survey data.

Details of the survey that pinpointed objectives, such as the reduction of inappropriate antibiotics, and obstacles to antimicrobial stewardship programs (ASP), including insufficient stewardship clinician time, were presented at the St. Jude/PIDS Pediatric Infectious Diseases Research Conference.

“Antimicrobial stewardship in pediatric cancer patients is especially important because these patients require frequent broad-spectrum antibiotics, but are also at very high risk of developing complications of antibiotic use including drug resistant infections, Clostridium difficile infection and severe toxicity due to predisposing problems or requirement for multiple drugs,” Joshua Wolf, MD, FRACP, of St. Jude Children’s Research Hospital, told Infectious Diseases in Children.

To obtain information about clinicians, ASP, primary goals of intervention among pediatric cancer patients and the perceived barriers to effective stewardship, Wolf and colleagues sent a questionnaire to a network of ASP clinicians in North America and Australasia.

One hundred unique responses were obtained from clinicians, including:

infectious disease physicians (56%);
clinical pharmacists (29%); and
infectious disease fellows (14%).

“Surprisingly, we found that regardless of differences between clinicians or institutions there was a remarkable similarity between the goals and barriers they reported,” Wolf said. “The most commonly reported barriers in this setting included the perception that oncology clinicians are afraid of rare adverse outcomes (89%) but not financial costs (73%), and they are confident in current antibiotic strategies (87%).”

The most commonly reported goals were to reduce initiation of inappropriate antibiotics (62%) and the time to de-escalation (74%). In addition, the majority of clinicians (59%) noted that they directed no less than 10% of their work effort to ASP.

“These data provide the first understanding that stewardship clinicians in multiple hospitals in multiple countries are all focused on similar goals and perceive many of the same challenges,” Wolf said. “This suggests that we could collaborate to do further research on the best ways to achieve these goals and overcome these challenges.”

Reference:

Wolf J, et al. Abstract R201538. Presented at: St. Jude/PIDS Pediatric Infectious Diseases Research Conference; Feb. 20-21, 2015; Memphis, Tennessee.

Disclosure: The researchers report no relevant financial disclosures.