Comparative Analysis of Antibiotic Usage among Patients with Leukemia Experiencing Chemotherapy-Induced Fever and Neutropenia in Armenia

Background

Pediatric cancer immunocompromised patients are more susceptible to various infections. Hence, efficient and safe antimicrobial management can prevent and/or properly manage life-threatening infections among this vulnerable group of patients. Investment in antimicrobial stewardship programs in developing countries is inevitable and will ensure improved healthcare outcomes, particularly for immunocompromised patients.

The research aims to retrospectively analyze infection management among immunocompromised children with a diagnosis of leukemia, who are more susceptible to infectious complications. This situational analysis is the first step to highlight the need for antimicrobial stewardship program investment in the clinical setting and ensure further steps toward improvements. Moreover, the research will be a good base for improving local febrile neutropenia management guidelines.

Methods and Materials

Electronic versions of paper-based medical records for pediatric leukemia patients were reviewed to extract data on fever and neutropenia episodes in 2020 and 2022. The extracted data included age, the onset date of fever, patient complaints, antibiotic initiation and cessation dates, identified sources of infection, and subsequent clinical outcomes. We assessed the non-prophylactic antibiotic utilization in 2022 by estimating Days of Therapy (DOTs), Length of Therapy (LOTs), and DOT-LOT ratio. The data was entered and analyzed using Microsoft Excel 2016.

Results

In total, 814 medical charts were enrolled. In 311 medical records from 2020, fifty-two fever and neutropenia episodes were met. Compared with 2022, 503 medical records 104 febrile neutropenia episodes were reported. The most common non-prophylactic antibiotics used in 2020 were cephalosporins (50/110), meropenem (16/110), and fluoroquinolones (12/110) versus cephalosporins (81/185), meropenem (25/185), and metronidazole (20/185) in 2022 (table 1). The increase in the use of metronidazole and oral vancomycin in 2022 is associated with higher rates of Clostridioides difficile infection or availability of diagnostic modalities compared with 2020. Clinically identified sources were in 26 out of 52 in 2020 versus 42 out of 104 patient episodes in 2022. Febrile neutropenia episodes with positive blood culture were 16 out of 52 episodes (2020) versus 25 out of 104 episodes (2022). Out of 52 patient episodes (2020), 50 received antibiotic treatment. Days of Therapy (DOTs) per 100 patient days were 70.4. Out of 104 patient episodes (2022), 99 received antibiotic treatment. DOTs per 100 patient days were 102.5. The length of therapy per 100 patient days (LOTs) was 68.2. The DOT-LOT ratio was 1.5.

Conclusions

Overall, antibiotic utilization was higher in 2022 (DOTs of 102.5 vs. 70.4). Differences in antimicrobial utilization among pediatric immunocompromised patients between 2020 and 2022 could be attributed to new diagnostic methods investment in clinical settings. However, the research results suggest that an antimicrobial stewardship program is needed to ensure safe antimicrobial treatment. Further research is needed to elicit the factors associated with the increased use of antibiotics in 2022.