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