Impact of an antimicrobial stewardship intervention on carbapenem use in children with cancer.

PURPOSE: Infections during neutropenia are​ a potentially life-threatening complication​ in pediatric oncology. International guidelines recommend antipseudomonal β-lactam monotherapy for stable patients, however, modification​ to carbapenems often occurs without confirmed infection.​

METHODS

We conducted​ a retrospective cohort study​ at​ a single tertiary pediatric oncology center to assess the impact​ of​ a carbapenem-sparing AMS intervention​ in children during neutropenia. All pediatric cancer patients with​ at least one episode​ of​ suspected infection between January 2021 and October 2024 were included.​ The intervention combined training, updated standard operating procedures, multidrug-resistant (MDR) surveillance swabs, and​ a structured protocol reassessing meropenem treatment​.

RESULTS

Among 254 patients, 116 met the inclusion criteria, accounting for 432​ episodes (270 pre- and 162 post-intervention). Re-modification​ of antimicrobial therapy from meropenem​ to piperacillin/tazobactam was achieved​ in​ 16​ of​ 50 post-intervention episodes. The median duration​ of meropenem treatment decreased from​ 9​ to​ 6 days​ (p​ = 0.006). Interrupted time series analysis showed​ a non-significant reduction​ in meropenem use, corresponding​ to​ an estimated decline​ of 40.7 days of therapy (DOT) per 1000 patient-days per quarter. Mortality was unchanged (3.8%​ vs 4.3%).

CONCLUSION

Our findings demonstrate that a structured AMS intervention is feasible and effective​ in pediatric oncology, reducing unnecessary meropenem exposure without compromising safety. While this approach may serve​ as​ a model for broader multicenter efforts​ to promote individualized, evidence-based antimicrobial use, the low number​ of blood stream infections (BSI)​ in our cohort limits the ability​ to draw definitive conclusions about the clinical impact​ of MDR screening​ on infection-related outcomes.