ABSTRACT
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= â6951; 30.1%) followed by Klebsiella pneumoniae (n â= â5801; 25.1%) and Pseudomonas aeroginosa (n â= â3041; 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.
Subject(s)
Antimicrobial Stewardship , Cross Infection , Humans , Cross Infection/drug therapy , Cross Infection/epidemiology , Cross Infection/etiology , Anti-Bacterial Agents/therapeutic use , Anti-Bacterial Agents/pharmacology , Escherichia coli , Retrospective Studies , Drug Resistance, Bacterial , Infection ControlABSTRACT
Peripherally inserted central catheters (PICC) are widely used in oncology for administration of chemotherapy. However, sometimes there may be complications associated with them such as infections, thrombosis and rarely fracture of catheter and embolization of the catheter fragments. Here we report a case of 59-year old gentleman with locally advanced carcinoma of head of pancreas, who had spontaneous fracture of a silicon based PICC and later migration of the catheter fragment through the heart and further into the right pulmonary arterial system. The embolized catheter fragment was retrieved through a vascular snare from the right femoral venous route. This case highlights the fact that silicon PICCs are fragile and have a high risk of spontaneous dislodgement and should be replaced by better alternative polyurethane PICCs.
Subject(s)
Catheter-Related Infections , Catheterization, Central Venous , Catheterization, Peripheral , Central Venous Catheters , Hypertension, Pulmonary , Catheterization, Central Venous/adverse effects , Catheterization, Peripheral/adverse effects , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , SiliconABSTRACT
BACKGROUND: Immune check point inhibitors (ICIs) have changed the treatment paradigm of driver mutation negative non-small cell lung cancer (NSCLC) and they are increasingly incorporated in first-line treatment. Real-world experience of use of these drugs is limited. We aim to evaluate the real-world experience of use of ICIs in patients with advanced NSCLC. PATIENTS AND METHODS: Medical records of patients with NSCLC treated with ICIs at 4 major academic cancer centers in India between January 2016 and December 2018 were analyzed. The type of ICI taken, response rates, survival, and toxicity profiles were analyzed. RESULTS: The median age at presentation was 60 years (range: 27-79 years). Nivolumab was the most commonly used ICI drug [80%, nâ¯=â¯70] followed by pembrolizumab [10%, nâ¯=â¯9], and atezolizumab [10%, nâ¯=â¯9]. The median number of ICIs cycles received were 4 (range 2-65). Among the evaluable responses in 74 patients, the objective response rates was 25.6% and clinical benefit rate was 46%. Immune related toxicity occurred in 39.9% of patients but, severe toxicity of Grade III and Grade IV occurred in 5 (5.6%) patients. After a median follow-up time of 8.86 months (95%CI 5.2-11.1) the progression-free survival was 4.73 months (95%CI 3.7-8.9), and overall survival was 11.6 months (95%CI 7.33-NR). ECOG PS at the time of start of ICIs was found to be significant determinant of Progression-free survival and overall survival. CONCLUSION: Our study demonstrates the feasibility of usage of ICIs in advanced NSCLC in Indian setting with acceptable safety profile and comparable responses with the published studies.
