ABSTRACT
The aim of this study was to determine the incidence and causes of fever as a major problem contributing to transplantation related mortality among patients undergoing hematopoietic stem cell transplantation [HSCT] and evaluation of antibiotic use, according to reliable guidelines.We retrospectively reviewed hospital records of 195 adult patients who underwent HSCT between 2009-2011 at hematologyoncology and bone marrow transplantation research center. Baseline information and also data related to fever and neutropenia, patient's outcomes, duration of hospitalization and antibiotic use pattern were documented.A total of 195 patients were analyzed and a total of 268 febrile episodes in 180 patients were recorded [mean 1.5 episodes per patient]. About 222 episodes [82%] were associated with neutropenia which one-fourth of them were without any documented infection sources. Microbiologic documents showed that the relative frequencies of gram positive and gram negative bacteria were 62.5% and 37.5%, respectively. The hospital stay duration was directly related to the numbers of fever episodes [P<0.0001].The rate of febrile episodes in autologous stem cell transplantation was significantly higher compared to allogeneic type [P<0.05].It is necessary to determine not only the local profile of microbiologic pattern, but also antibiotic sensitivities in febrile neutropenic patients following hematopoietic stem cell transplantation, and reassess response to antibiotic treatment to establish any necessity for modifications to treatment guidelines in order to prevent any fatal complications from infection
Subject(s)
Humans , Male , Female , Hematopoietic Stem Cell Transplantation , Incidence , Anti-Bacterial AgentsABSTRACT
Inappropriate use of drugs is a widespread problem with serious consequences such as increased adverse drug reaction and antimicrobial resistance. Proper interventions would have important financial and public health benefits. Several studies have been performed about Rational Drug Use [RUD] in Iran. To provide a picture of researches were done about RUD and highlight the existing gaps in practice in Iran, a systematic search was conducted by reviewing all papers [English and Persian] found by searching keywords in Pubmed, Web of Science, Google Scholar, CINAHL, Proquest, International Pharmaceutical Abstract [IPA], SID, Iran Medex and MagIran. Retrieved articles were extracted in Access form and exported to Excel for further analysis. After excluding duplicate and irrelevant articles, 466 related articles were remained. Number of publications increased dramatically after 2001. About 73% of studies were cross-sectional. Evaluation of prescribing pattern [15%], self-medication [11.3%] and adverse drug reaction [9.1%] were among the top topics which were studied. Despite an increasing trend in RUD publications in Iran, still large gaps remain to be investigated. Knowing the existing gaps is crucial for policy makers to make investments to solve the problems
Subject(s)
Bibliography of Medicine , Bibliographies as Topic , Publications , Pharmaceutical PreparationsABSTRACT
Albumin is a protein colloidal solution that possesses great value in the clinic, particularly for the resuscitation of critically ill patients. It has accounted for a high percentage of the cost in our center. This study evaluates the appropriateness of albumin usage at Masih Daneshvari Hospital, Tehran, Iran. This study evaluated 69 patient charts. Data included patient demographics, ward of admission, primary reasons for prescribing albumin, and details of albumin use. Possible correlations between the appropriateness of albumin usage, the number of albumin vials, and mortality rate were analyzed. Albumin was prescribed appropriately in 63.8% of patients. Cardiac surgery accounted for 37.3% of all indications. The most prevalent inappropriate indication of used albumin was for mild hypoalbuminemia and nutritional support. There was a significant correlation between the number of used albumin vials and mortality rate. In conclusion, the albumin use in Masih Daneshvari Hospital was not completely in accordance with the accredited references. Albumin is an expensive medication prescribed unnecessarily for many patients. Using the clinical pharmacist's prepared guideline could minimize the situations where its administration is not needed
ABSTRACT
Infectious diseases are one of the most common causes of morbidity and mortality and the spread of resistant microorganisms is playing a significant role in this regard. The purpose of this study was to assess the trend in antimicrobial resistance of gram-positive bacteria at the main referral teaching hospital in Tehran during a 4-year period. All patients' biological isolates such as blood, urine, wound drainage, synovial fluid, sputum, and cerebrospinal fluid sent to the central laboratory of the hospital from 2007 to 2010 for identification and subsequently, antimicrobial susceptibility testing by Kirby-Bauer disc diffusion method were considered. All isolates [100%] of S. aureus were sensitive to vancomycin and linezolid and resistant to amoxicillin. The rate of S. aureus resistance to oxacillin increased from 60.78% in 2007 to 72% in 2010. All isolates of Streptococci in 2007 and 2008 were sensitive to vancomycin; while, 3.33% and 4.76% of Streptococci isolates were reported to be vancomycin-resistant in 2009 and 2010, respectively. Enterococci isolated from the entire specimens were identified to be sensitive to teicoplanin and linezolid and resistant to cloxacillin and oxacillin. The rates of Enterococci sensitivity to vancomycin were 90.91%, 81.25%, 86.67%, and 93.3% in 2007, 2008, 2009, and 2010, respectively. Changes of antibiotics sensitivity against g positive pathogens were significant during four years in this study. To minimize the spread of resistant gram positive pathogens, periodic and regular surveillance of antimicrobial resistance pattern is highly recommended.