Impact of improving infection control and antibiotic stewardship practices on nosocomial infections and antimicrobial resistance in an oncology centre from India.

BACKGROUND: Improving basic infection control (IC) practices, diagnostics and anti-microbial stewardship (AMS) are key tools to handle antimicrobial resistance (AMR). MATERIALS AND METHODS: This is a retrospective study done over 6 years (2016-2021) in an oncology centre in North India with many on-going interventions to improve IC practices, diagnostics and AMS. This study looked into AMR patterns from clinical isolates, rates of hospital acquired infections (HAI) and clinical outcomes. RESULTS: Over all, 98,915 samples were sent for culture from 158,191 admitted patients. Most commonly isolated organism was E. coli (n â€‹= â€‹6951; 30.1%) followed by Klebsiella pneumoniae (n â€‹= â€‹5801; 25.1%) and Pseudomonas aeroginosa (n â€‹= â€‹3041; 13.1%). VRE (Vancomycin resistant Enterococcus) rates fell down from 43.5% in Jan-June 2016 to 12.2% in July-Dec 2021, same was seen in CR (carbapenem resistant) Pseudomonas (23.0%-20.6%, CR Acinetobacter (66.6%-17.02%) and CR E. coli (21.6%-19.4%) over the same study period. Rate of isolation of Candida spp. from non-sterile sites also showed reduction (1.68 per 100 patients to 0.65 per 100 patients). Incidence of health care associated infections also fell from 2.3 to 1.19 per 1000 line days for CLABSI, 2.28 to 1.88 per 1000 catheter days for CAUTI. There was no change in overall mortality rates across the study period. CONCLUSION: This study emphasizes the point that improving compliance to standard IC recommendations and improving diagnostics can help in reducing the burden of antimicrobial resistance.

Serpentine Supra-venous Hyperpigmentation "Badge of Courage" in Fight Against Cancer: An Brief Review.

Persistent serpentine supra-venous hyperpigmentation (PSSH) describes a hyperpigmentation of the skin overlying peripheral veins with characteristic of underlying vessels that are patent. It has been described most commonly after injection of chemotherapeutic drugs. We describe a 44 year old man with diagnosed case of Ca stomach on FOLFOX based chemotherapy. After the 1st cycle of Chemotherapy he developed serpentine supra-venous hyperpigmentation. Introduction: Conventional chemotherapy agents commonly cause infusion-site lesions, such as chemical cellulitis due to drug extravasation and evanescent eruptions.(1) 5-Fluorouracil (5-FU) is a cytotoxic agent used mostly in combination to treat a variety of malignant disorders. Hyperpigmentation is a rare side effect occurring with 5-FU infusions; it has been reported in 2-5% of patients. Various types of pigmentary abnormalities have been reported with 5-FU use such as diffuse hyperpigmentation of the face and palms, macular pigmentary changes on the palms and soles, hyperpigmentation overlying the superficial venous network also called serpentine supravenous hyperpigmentation (SSH) and persistent supravenous erythematous eruptions (PSEE).(2) Keywords: Serpentine Supra-venous Hyperpigmentation, Dermatological toxicity, Fluorouracil.