RESUMO
Background: Increasing bacterial resistance to antimicrobial agents is resulting in high morbidity and mortality. Antimicrobial stewardship (AMS) programs aim at rationale use of antimicrobial agents in clinical settings by development and implementation of antibiotic policy. As the patterns of antimicrobial resistance vary with organism and time, there is a need for periodic surveillance. Aims and Objectives: The aim of the study was to study the impact of AMS program on appropriate use of antimicrobial agents and clinical outcomes in patients with multidrug-resistant Gram-negative bacterial (MDR GNB) infections. Materials and Methods: This is a prospective observational study that included patients diagnosed with multidrug-resistance Gram-negative bacterial infections during June to July 2019. Identification of multidrug-resistant organisms was performed as per clinical and laboratory standards institute guidelines 2016. Information on the use of empirical antibiotic and other antimicrobial agents after culture and sensitivity report were collected and assessed for appropriateness. All the patients were followed up till discharge. Results: From 170 patients, there were 211 specimens sent for culture and sensitivity and 249 pathogens were isolated. The most frequent pathogen isolated was Escherichia coli (42.6%) followed by Klebsiella spp. (22.9%). Isolates were most resistant to cefazolin (86.7%) and ceftriaxone (83.9%), and most sensitive to polymyxin B (100%) and tigecycline (97.2%). All patients were administered antimicrobial agents as per antibiotic policy of the institute and 154 (90.6%) patients have recovered from illness with a mean length of hospital stay of 19.4 ± 6.6 days. Conclusion: Adherence to antimicrobial policy helps in improved outcomes in patients with MDR GNB infections. Hence, the need to implement AMS program in all hospitals.
RESUMO
Background: Many newer drugs are approved every year for the treatment of cancers. With the limitation of clinical trials data on long-term safety, there is a need for constant monitoring of drugs use in various population. Occurrence of adverse drug reactions (ADRs) due to anticancer drugs is high due to their cytotoxic effects. Aims and Objectives: This study aims to analyze ADR reported due to anticancer drugs in relation to frequency of their occurrence, causality, severity, and preventability. Materials and Methods: This was a retrospective analysis of ADRs due to cancer chemotherapeutic agents that were spontaneously reported between January 2017 and June 2018. Data were collected from the suspected ADR notification forms submitted to ADR Monitoring Centre of the institute. Data were analyzed for type of cancers, medications used, type of ADRs, causality assessment, severity, and preventability. Results: A total of 545 ADRs were reported from 391 cases, with majority in females (65.1%). Breast was more commonly involved cancer (16.62%) and cisplatin was the common individual drug reported to cause ADRs (16.15%). The most common ADR reported was paresthesia (13.03%) followed by diarrhea (12.29%). Causality assessment revealed that most cases were probably related (61.65%). Most of the cases were moderately severe (61.28%) and most of the reported ADRs were not preventable (72.65%). Conclusion: Toxicities due to anticancer drugs can affect different organs. Most of the reported cases in this study are not preventable and of moderately severe. Appropriate use of preventive strategies helps in reduction in the occurrence and severity of ADRs.