Do Weekly Surveillance Cultures Contribute to Antibiotic Stewardship and Correlate with Outcome of HSCT in Children?

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Increasing antimicrobial resistance (AMR) is one of the top global public health threats facing humanity, necessitating improvements in antibiotic stewardship. The increasing trend of AMR also has been reported specifically in the context of hematopoietic stem cell transplantation (HSCT). In the HSCT context, aggressive treatment of fevers and infections is criticall. Nevertheless, early use of broad-spectrum antibiotics has been identified as an independent risk factor for adverse outcomes after bone marrow transplantation

We were interested to see if we could pre determine the possible antibiotics to be used in case of a patient turns febrile due to a potential infectious complication. That is when we started doing weekly rectal swab surveillance cultures to identify gut colonisation and guide empirical antibiotic therapy. This practice was stared more than 4 years ago. A comprehensive retrospective analysis was done.

We failed to observe any usefulness of RSSCs either in antibiotic stewardship strategies or in terms of long-term outcome prediction. Even though our study has the limitation of an observational design, it provides real-world evidence on the usefulness of RSSCs as a component of the antibiotic stewardship toolkit. Our findings highlight the limitations and even potential collateral damage of RSSC-guided antibiotic selection.

We are grateful to patients and their families, as well as the staff at all the institutions involved in caregiving for their role in the treatment and also making this assessment. We thank Cure2Children and Jagriti Innovations who made significant contributions for this study to be realized and published

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