Are hematopoietic cell transplant recipients with Gram‐negative bacteremia spending more time outpatient while on intravenous antibiotics? Addressing trends over 10 years at a single center

Abstract Introduction The increasing proportion of outpatient allogeneic hematopoietic cell transplants (HCTs) coupled with increased access of once‐daily broad‐spectrum antibiotics and evidence that outpatient antibiotic treatment may be safer and less costly than inpatient treatment, suggest that...

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Autores principales:	Margaret L. Lind, Steven Roncaioli, Catherine Liu, Andrew Bryan, Ania Sweet, Frank Tverdek, Mohamed Sorror, Amanda I. Phipps , Steven A. Pergam
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	ambulatory care antibiotic stewardship Gram‐negative rod bacteremia hematopoietic cell transplant outpatient care Immunologic diseases. Allergy RC581-607
Acceso en línea:	https://doaj.org/article/d71d040688a243f987a5bc6bcc830a96
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spelling	oai:doaj.org-article:d71d040688a243f987a5bc6bcc830a962021-11-12T19:57:15ZAre hematopoietic cell transplant recipients with Gram‐negative bacteremia spending more time outpatient while on intravenous antibiotics? Addressing trends over 10 years at a single center2050-452710.1002/iid3.486https://doaj.org/article/d71d040688a243f987a5bc6bcc830a962021-12-01T00:00:00Zhttps://doi.org/10.1002/iid3.486https://doaj.org/toc/2050-4527Abstract Introduction The increasing proportion of outpatient allogeneic hematopoietic cell transplants (HCTs) coupled with increased access of once‐daily broad‐spectrum antibiotics and evidence that outpatient antibiotic treatment may be safer and less costly than inpatient treatment, suggest that allogeneic HCT recipients with Gram‐negative rod bacteremia (GNRBs) are increasingly being treated in ambulatory care settings. Methods Using data from the first GNRB event that occurred within the first 100 days posttransplantation among allogeneic HCT recipients transplanted at a single center between 2007 and 2016, we estimated the temporal trends in GNRB incidence and treatment management of GNRBs and identified if patient or infection characteristics impacted observed trends. Results A total of 11% (238/2165) of the observed allogeneic HCT recipients experienced ≥1 GNRB with available resistance data and contributed antibiotic treatment time. Patients, on average, received 55.1% of their antibiotic treatment in an outpatient setting and we observed a significant decline in the proportion of treatment time spent outpatient (crude: −3.3% [95% confidence interval: −5.0, −1.6%]). We observed similar declines in the proportion of treatment time spent outpatient among patients with similar GNRB and pretransplant complexity factors but not among patients with similar posttransplant complications (p value: .165). Conclusion These results suggest that, despite increased availability of outpatient suitable treatment options, allogeneic HCT recipients with GNRBs received less treatment in outpatient settings. However, among patients with similar posttransplant complications, the lack of significant decline suggests that treatment location decisions remained consistent for patients with similar posttransplant complications. These findings suggest the need for additional interventions targeting outpatient antibiotic treatment among allogeneic HCT recipients with GNRBs.Margaret L. LindSteven RoncaioliCatherine LiuAndrew BryanAnia SweetFrank TverdekMohamed SorrorAmanda I. Phipps Steven A. Pergam Wileyarticleambulatory careantibiotic stewardshipGram‐negative rod bacteremiahematopoietic cell transplantoutpatient careImmunologic diseases. AllergyRC581-607ENImmunity, Inflammation and Disease, Vol 9, Iss 4, Pp 1786-1794 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	ambulatory care antibiotic stewardship Gram‐negative rod bacteremia hematopoietic cell transplant outpatient care Immunologic diseases. Allergy RC581-607
spellingShingle	ambulatory care antibiotic stewardship Gram‐negative rod bacteremia hematopoietic cell transplant outpatient care Immunologic diseases. Allergy RC581-607 Margaret L. Lind Steven Roncaioli Catherine Liu Andrew Bryan Ania Sweet Frank Tverdek Mohamed Sorror Amanda I. Phipps * Steven A. Pergam * Are hematopoietic cell transplant recipients with Gram‐negative bacteremia spending more time outpatient while on intravenous antibiotics? Addressing trends over 10 years at a single center
description	Abstract Introduction The increasing proportion of outpatient allogeneic hematopoietic cell transplants (HCTs) coupled with increased access of once‐daily broad‐spectrum antibiotics and evidence that outpatient antibiotic treatment may be safer and less costly than inpatient treatment, suggest that allogeneic HCT recipients with Gram‐negative rod bacteremia (GNRBs) are increasingly being treated in ambulatory care settings. Methods Using data from the first GNRB event that occurred within the first 100 days posttransplantation among allogeneic HCT recipients transplanted at a single center between 2007 and 2016, we estimated the temporal trends in GNRB incidence and treatment management of GNRBs and identified if patient or infection characteristics impacted observed trends. Results A total of 11% (238/2165) of the observed allogeneic HCT recipients experienced ≥1 GNRB with available resistance data and contributed antibiotic treatment time. Patients, on average, received 55.1% of their antibiotic treatment in an outpatient setting and we observed a significant decline in the proportion of treatment time spent outpatient (crude: −3.3% [95% confidence interval: −5.0, −1.6%]). We observed similar declines in the proportion of treatment time spent outpatient among patients with similar GNRB and pretransplant complexity factors but not among patients with similar posttransplant complications (p value: .165). Conclusion These results suggest that, despite increased availability of outpatient suitable treatment options, allogeneic HCT recipients with GNRBs received less treatment in outpatient settings. However, among patients with similar posttransplant complications, the lack of significant decline suggests that treatment location decisions remained consistent for patients with similar posttransplant complications. These findings suggest the need for additional interventions targeting outpatient antibiotic treatment among allogeneic HCT recipients with GNRBs.
format	article
author	Margaret L. Lind Steven Roncaioli Catherine Liu Andrew Bryan Ania Sweet Frank Tverdek Mohamed Sorror Amanda I. Phipps * Steven A. Pergam *
author_facet	Margaret L. Lind Steven Roncaioli Catherine Liu Andrew Bryan Ania Sweet Frank Tverdek Mohamed Sorror Amanda I. Phipps * Steven A. Pergam *
author_sort	Margaret L. Lind
title	Are hematopoietic cell transplant recipients with Gram‐negative bacteremia spending more time outpatient while on intravenous antibiotics? Addressing trends over 10 years at a single center
title_short	Are hematopoietic cell transplant recipients with Gram‐negative bacteremia spending more time outpatient while on intravenous antibiotics? Addressing trends over 10 years at a single center
title_full	Are hematopoietic cell transplant recipients with Gram‐negative bacteremia spending more time outpatient while on intravenous antibiotics? Addressing trends over 10 years at a single center
title_fullStr	Are hematopoietic cell transplant recipients with Gram‐negative bacteremia spending more time outpatient while on intravenous antibiotics? Addressing trends over 10 years at a single center
title_full_unstemmed	Are hematopoietic cell transplant recipients with Gram‐negative bacteremia spending more time outpatient while on intravenous antibiotics? Addressing trends over 10 years at a single center
title_sort	are hematopoietic cell transplant recipients with gram‐negative bacteremia spending more time outpatient while on intravenous antibiotics? addressing trends over 10 years at a single center
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/d71d040688a243f987a5bc6bcc830a96
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Are hematopoietic cell transplant recipients with Gram‐negative bacteremia spending more time outpatient while on intravenous antibiotics? Addressing trends over 10 years at a single center

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