Current state of antimicrobial stewardship at solid organ and hematopoietic cell transplant centers in the United States Journal Article


Authors: Seo, S. K.; Lo, K.; Abbo, L. M.
Article Title: Current state of antimicrobial stewardship at solid organ and hematopoietic cell transplant centers in the United States
Abstract: OBJECTIVE To assess the extent of antimicrobial stewardship programs (ASPs) at solid organ transplant (SOT) and hematopoietic cell transplant (HCT) centers in the United States. DESIGN An 18-item voluntary survey was developed to gauge current antimicrobial stewardship practices in transplant patients, examine the availability and perceived usefulness of novel diagnostics and azole levels to guide therapy, and identify challenges for implementation of ASPs at these centers. PARTICIPANTS The survey was distributed electronically to infectious disease physicians and pharmacists at adult and pediatric SOT and HCT centers during May 1-22, 2015. Facilities were deidentified. RESULTS After duplicate removal, 71 (56%) of 127 unique transplant centers in 32 states were analyzed. Forty-four sites (62%) performed at least 100 SOT annually, and 40 (56%) performed at least 100 HCT annually. Top 5 stewardship activities encompassing transplant patients were formulary restriction, guideline development, prospective audit and feedback, education, and dose optimization. Respiratory viral panels (66/66 [100%]), azole levels (64/66 [97%]), and serum/bronchoalveolar lavage galactomannan (58/66 [88%]) were perceived as most useful to guide therapy. Apparent challenges to antimicrobial stewardship included undefined duration for certain infections (53/59 [90%]), diagnostic uncertainty (47/59 [80%]), the perception that antibiotic-resistant infections required escalation (42/59 [71%]), prescriber opposition (41/59 [69%]), and costly drugs (37/59 [63%]). CONCLUSIONS ASP activities were performed at many adult and pediatric SOT and HCT centers in the United States. Diagnostic and therapeutic uncertainty in transplant patients is challenging for ASPs. Collaborative research should examine the impact of antimicrobial stewardship practices in SOT and HCT. © 2016 by The Society for Healthcare Epidemiology of America.
Journal Title: Infection Control and Hospital Epidemiology
Volume: 37
Issue: 10
ISSN: 0899-823X
Publisher: The Society for Healthcare Epidemiology of America  
Date Published: 2016-10-01
Start Page: 1195
End Page: 1200
Language: English
DOI: 10.1017/ice.2016.149
PROVIDER: scopus
PUBMED: 27457099
PMCID: PMC5466005
DOI/URL:
Notes: Article -- Export Date: 2 November 2016 -- Source: Scopus
Altmetric
Citation Impact
MSK Authors
  1. Susan Seo
    78 Seo