Impact of an antimicrobial stewardship bundle on the outcome of high-risk neutropenic patients with fever: a pre-post study
Bibliographic record
Abstract
Abstract Background Rapid antibiotic initiation is essential for managing potential infections following chemotherapy-induced neutropenia. However, excessive use of broad-spectrum antibiotics should be avoided. Implementing antimicrobial stewardship (AMS) in haematology units is challenging due to high infection-related risks, and data on interventions remain scarce. This study aimed to evaluate the safety of an AMS bundle on a haematology ward. Methods A prospective cohort study was conducted at a tertiary care centre among patients with high-risk (≥7 days) neutropenia. The AMS bundle consisted of replacing empirical meropenem with ceftazidime, and shortening treatment duration to 2 days in case of defervescence and negative blood cultures. Data on ICU admission, all-cause mortality, antimicrobial use and microorganisms identified were compared with a (retrospective) pre-intervention cohort. Results A total of 396 patients were included (206 pre-intervention, 190 post-intervention). Allogeneic stem cell transplantations increased from 21% pre-intervention to 37% post-intervention. There was no statistical difference in the adjusted composite endpoint of ICU admission and all-cause mortality [adjusted HR (aHR) 1.46; 95% CI, 0.76–2.81; P = 0.26]. Pre-intervention, meropenem was prescribed in 99% of patients, which shifted to ceftazidime in 78% post-intervention. Median antibiotic treatment duration decreased from 8.0 to 5.0 days (P < 0.001), and empirical antibiotic consumption decreased from 12 to 8 days of therapy per patient (P < 0.001). Bloodstream infections with Candida spp. decreased from 17 pre-intervention to 5 post-intervention (P = 0.03). Conclusions The AMS bundle led to a shift towards narrower-spectrum antibiotics, and reduced treatment duration and overall antibiotic use without a significant impact on the primary safety outcome. The intervention was accompanied by a declining trend in candidaemia incidence.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".