Antimicrobial Use in Pediatric Oncology and Hematology: Protocol for a Multicenter Point-Prevalence Study With Qualitative Expert Panel Assessment

Cihan Papan; Katharina Reifenrath; Katharina Last; Andishe Attarbaschi; Norbert Graf; Andreas H Groll; Johannes Huebner; Hans-Jürgen Laws; Thomas Lehrnbecher; Johannes Liese; Luise Martin; Tobias Tenenbaum; Stefan Weichert; Simon Vieth; Ulrich von Both; Markus Hufnagel; Arne Simon

doi:10.2196/35774

Antimicrobial Use in Pediatric Oncology and Hematology: Protocol for a Multicenter Point-Prevalence Study With Qualitative Expert Panel Assessment

JMIR Res Protoc. 2022 Jun 20;11(6):e35774. doi: 10.2196/35774.

Authors

Cihan Papan^#¹, Katharina Reifenrath^#², Katharina Last¹, Andishe Attarbaschi³, Norbert Graf², Andreas H Groll⁴, Johannes Huebner⁵, Hans-Jürgen Laws⁶, Thomas Lehrnbecher⁷, Johannes Liese⁸, Luise Martin⁹, Tobias Tenenbaum¹⁰, Stefan Weichert¹⁰, Simon Vieth¹¹, Ulrich von Both⁵, Markus Hufnagel¹², Arne Simon²

Affiliations

¹ Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany.
² Pediatric Hematology and Oncology, University Children's Hospital, Saarland University, Homburg, Germany.
³ Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria.
⁴ Infectious Disease Research Program, Department of Pediatric Hematology/Oncology and Center for Bone Marrow Transplantation, University Children's Hospital Münster, Münster, Germany.
⁵ Division of Pediatric Infectious Disease, Dr v Hauner Children's Hospital, University of Munich, Munich, Germany.
⁶ Department of Pediatric Oncology, Hematology and Clinical Immunology, University of Duesseldorf, Düsseldorf, Germany.
⁷ Division for Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany.
⁸ Pediatric Infectious Diseases and Immunology, University Children's Hospital, University of Würzburg, Würzburg, Germany.
⁹ Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
¹⁰ Pediatric Infectious Diseases, Department of Pediatrics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
¹¹ Department of Pediatrics, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany.
¹² Division of Pediatric Infectious Diseases and Rheumatology, Department of Pediatrics and Adolescent Medicine, University Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany.

^# Contributed equally.

PMID: 35723906
PMCID: PMC9253971
DOI: 10.2196/35774

Abstract

Background: Because infections are a major driver of morbidity and mortality in children with hematologic or oncologic diseases, antimicrobials are frequently prescribed in pediatric oncology practice. However, excess or inappropriate use of antimicrobials is directly linked to the emergence of antimicrobial resistance. Although point-prevalence studies have examined the extent of antimicrobial use, a comprehensive qualitative evaluation of individual antimicrobial prescriptions remains lacking.

Objective: The aim of this study is to identify appropriate versus inappropriate antimicrobial use among pediatric cancer patients in a point-prevalence study, followed by an expert panel adjudication process and a subsequent report of these findings to participating centers. This study also aims to improve the quality of patient care by informing centers about discrepancies between internal standards of care and national guidelines.

Methods: Our point-prevalence study is performed at pediatric cancer centers in Germany and Austria. All patients under 18 years old who are hospitalized at the time of the study are included. As a supplement to the point-prevalence study, an expert panel is qualitatively assessing each of the antimicrobial prescriptions at the participating centers to review local guidelines and compare them with national guidelines.

Results: As of December 2021, the point-prevalence survey has been conducted at 30 sites and expert panel adjudication for qualitative assessment of each antimicrobial use is ongoing. Results of the study are expected in 2022.

Conclusions: This is the first point-prevalence study conducted among pediatric cancer centers with an integrated, multistep, qualitative approach that assesses each antimicrobial prescription. The results of this study will inform possible interventions for internal guidelines and antimicrobial stewardship programs implemented at pediatric cancer centers. In addition, local guidelines will be compared with national guidelines. Furthermore, this study will contribute to the overall integration of antimicrobial stewardship principles and initiatives in pediatric oncology and hematology, thereby improving safety and quality of care for children and adolescents with cancer and blood disorders.

International registered report identifier (irrid): DERR1-10.2196/35774.

Keywords: antimicrobial resistance; antimicrobial stewardship; cancer; expert panel; oncology; pediatric hematology; pediatric oncology; pediatrics; point-prevalence study.

©Cihan Papan, Katharina Reifenrath, Katharina Last, Andishe Attarbaschi, Norbert Graf, Andreas H Groll, Johannes Huebner, Hans-Jürgen Laws, Thomas Lehrnbecher, Johannes Liese, Luise Martin, Tobias Tenenbaum, Stefan Weichert, Simon Vieth, Ulrich von Both, Markus Hufnagel, Arne Simon. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 20.06.2022.