An Evidence-based Guideline for Patients with Acute Leukemia to Promote Antibiotic Stewardship
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Date
2022-05
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The Ohio State University
Abstract
Antibiotic overuse is a significant global problem accounting for increased health care spending and the emergence of multi-drug resistant organisms (MDROs) and Clostridium difficile infections in patients and the community. Patients with acute leukemia (AL) are particularly vulnerable populations treated with extensive antibiotics courses during their cancer treatment. An exhaustive search, evaluation, and synthesis of the literature point to implementing evidence-based practice guidelines to improve antibiotic stewardship and outcomes in patients with AL. Based on these findings, an evidence-based quality improvement project was undertaken at a large Midwestern academic medical center from September 2021 to December 2021. The purpose of the project involved the creation of an evidence-based practice guideline for managing febrile neutropenia in hospitalized patients with AL to promote antibiotic stewardship. The Model for Improvement conceptual framework served as the impetus for the practice change. Weekly audit and feedback using the Plan-Do-Study-Act (PDSA) cycle were employed to promote guideline fidelity across providers. Once guideline adherence was achieved at six weeks, long-term metrics for antibiotic utilization and Clostridium difficile rates for the inpatient unit were evaluated. Outcomes of the project revealed clinically meaningful reductions in antibiotic utilization and Clostridium difficile rates on the AL nursing unit. These findings yield encouraging results and highlight the importance of greater resource allocation for future projects to curb antibiotic misuse in this population
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Keywords
acute leukemia, febrile neutropenia, antibiotic stewardship, evidence-based practice guideline, audit and feedback, antibiotic utilization, Clostridium difficile