Antibiotic overuse and resistance problems have become a major public health issue worldwide (1). The inappropriate or overuse antibiotic usage, especially broad-spectrum agents results in the emergence and spread of antibiotic-resistant bacteria, which lead to increased morbidity, inpatient stays, and higher mortality (1, 2).
The problem of increasing antimicrobial resistance is especially critical for patients in the intensive care unit (ICU), because they are more susceptible to health care associated Infections (3).Increased multidrug resistance (MDR) organisms and Clostridium difficile infections have been involved in solid-organ transplant (SOT) recipients and have been associated with significant graft loss and mortality (4). Rates of bacterial infections in SOT recipients range from 21% to 68%, depending on transplant type and immunotherapy (5). Between 20 to 40% patients receiving bone marrow transplant (would require ICU admission in the initial post transplantation Phase and the rates of their mortality was around 60% which have been reported for infectious diseases (6). Similarly, the incidence of Clostridium difficile infection (CDI) in this population is increasing and characterized by more severe disease, frequent recurrences, and graft loss (4). There are limited treatment options for MDR organisms, and antibiotic exposure remains the principal risk factor for CDI. Therefore, transplant providers, patient safety plan and programmatic interventions focusing on prevention are an emerging problem (4, 7).
Furthermore, the unrealized microbiome effects of altering immune function may predispose to allograft rejection. (4). Over the past few decades, published literature related to safety and efficacy of antibiotic stewardship strategies in high-risk immunocompromised hosts such as SOT recipients and those with hematologic malignancies exposed to cytotoxic chemotherapy and prolonged neutropenia is limited (8).
Multidrug resistance (MDR) is defined as resistant microorganism to the administered antimicrobial agents despite earlier sensitivity to it. These resistant microorganisms could rise in immunocompromised conditions, like individuals who have undergone organ transplantation leads further spread of MDR (9).
There has been a dramatic reduction in the development of antimicrobial agents with novel mechanisms of action to combat the rising spread of infections caused MDR organisms, although implementation challenges in immunocompromised hosts have been described (4,8). In general, antimicrobial-stewardship programs (ASPs) can help to improve clinical outcomes, limit antibiotic resistance and reduce medical costs by limiting the inappropriate use of antimicrobials in hospitals (1, 3, 10).
It is unknown whether antimicrobial stewardship efforts are enclosing only the general patient population or whether immunocompromised hosts such as cancer and SOT are being included (7, 8). Duration of antimicrobial therapy and difficulty with source control is not clearly defined in many infections for immunocompromised hosts which may lead clinicians to prescribe broader and longer courses of antimicrobials than they would with a normal host (5, 8).
Among adult hospital ASPs, studies have indicated a reduction in the hospital length of stay in ICU, a decrease in C.difficile rates, and a development in antibiotic susceptibilities of common pathogens (10). Adherence to antibiotic guidelines varies among countries and institutions and the results of a recent comprehensive, antimicrobial stewardship program among adult hospital ASPs, studies have indicated a reduction in the hospital length of stay in ICU, a decrease in C. difficile rates, and a development in antibiotic susceptibilities of common pathogens (3, 11).The objective of this study was to determine the impact of a hospital ASP on antimicrobial resistant, clostridium difficile rates and amount of antimicrobial consumed meropenem (MPM) and vancomycin (VMN) in cancer patients.