Indication-based Antimicrobial Derestriction: Ceftazidime Derestriction for Febrile Neutropenia

Sta2s2cal Analysis Febrile neutropenia (FN) is a common condi2on in children receiving chemotherapy and can be life-­‐threatening. The University of Chicago Comer Children’s Hospital has a rigorous an2microbial restric2on and prior authoriza2on policy overseen by the An2microbial Stewardship Program (ASP). • CeIazidime (CTZ), our agent of choice for FN, is restricted. • Use requires calling Infec2ous Diseases (ID) on call for approval, followed by ID calling pharmacy with authoriza2on, leading to a poten2al delay in order processing. • FN is recognized as a 2me-­‐sensi2ve disease state with a clear indica2on for empiric an2bio2c (i.e. CTZ) use. • FN clinical pathway was revised, removing the need for prior approval, or “derestric2on”. • Goal of the revised clinical pathway and derestric2on is to promote the most appropriate, targeted and 2mely care to those high-­‐risk pediatric FN pa2ents. • Derestric2on serves to minimize the 2me between ini2al pa2ent presenta2on and 2me to an2bio2c administra2on. • New clinical pathway provides guidance for the ini2al workup and an2microbial management. • Indica2on-­‐based an2bio2c ordering and derestric2on can be successfully implemented in an ASP with a historically restric2on-­‐based system, without significant change in the appropriate use of the derestricted agent, change in the rate of bloodstream infec2ons or pa2ent outcomes. • The ED serves as the most efficient administrator of CTZ within the goal of less than 60 minutes. • Other units (i.e. clinic and inpa2ent unit) do not meet the desired less than 60 minute standard. Future efforts will be directed towards evalua2ng addi2onal factors affec2ng 2me to CTZ administa2on administra2on, specifically within the clinic and inpa2ent seYngs.