Predictors and outcomes of multi-drug-resistant gram-negative bacteremia in patients with cancer: A retrospective cohort study at a tertiary cancer center in Oman.

Objectives: This study aimed to delineate the characteristics and outcomes of gram-negative bacteremia (GNB) in oncology patients; analyze the risk factors for multi-drug-resistant (MDR) GNB; and assess its impact on the recurrence of bloodstream infection (BSI), hospital stay, and 30-day mortality. Methods: Data, including demographics, clinical features, common cancers, and microbiologic findings, were collected retrospectively from electronic medical records of patients admitted with solid tumors and BSI episodes between January and December 2022. Fisher's exact tests were used to determine the effect of MDR-GNB on 30-day mortality and BSI recurrence. The Wilcoxon rank-sum test assessed the differences in the length of hospital stay. Logistic regression models identified the risk factors for MDR-GNB. Results: Among 1074 patients, 77 episodes of GNB bacteremia occurred in 59 individuals (47% male, median age 57.4 years). Of these, 37 (48%) were MDR-GNB. Carbapenem resistance was noted in 9.1% of GNB episodes. Previous antibiotic use was significantly associated with MDR-GNB (odds ratio 7.82; 95% confidence interval 2.52-24). MDR-GNB was linked to longer hospital stays (median 23 vs 10.5 days, P = 0.003) and higher recurrence rates than non-MDR-GNB (35.13% vs 5.0%, P <0.001). However, 30-day mortality did not significantly differ between the groups (35.14% vs 32.5%, P = 0.81). Conclusion: Previous antibiotic use predicted MDR-GNB in patients with solid tumor. MDR-GNB bacteremia increased the length of hospital stay and risk of recurrence compared with non-MDR-GNB bacteremia.

Clinical and Cost Implications of Clinical Pharmacist Interventions on Antimicrobial Use at Sultan Qaboos University Hospital in Oman.

OBJECTIVE: To evaluate the clinical and financial impact of clinical pharmacists' interventions (CPIs) on antimicrobial use at a 500-bed multidisciplinary tertiary care hospital in Oman. METHODS: A retrospective analysis of CPIs related to antimicrobials use at Sultan Qaboos University Hospital (SQUH) from January to December 2018. Interventions were recorded using an electronic CPI form and were reviewed by two independent CPs. Data on the type and clinical significance of the interventions were extracted. Cost analysis was done using a previously defined cost avoidance model in addition to direct cost reduction estimation. Descriptive data were used to describe the results. RESULTS: In 2018, 26% of CPIs were related to antimicrobial use, with more than 60% of these interventions done on intensive care unit patients. The most common intervention type was adjusting the dosing regimen (42% of the total interventions), followed by deletion of the antimicrobial order in 34% of the cases. The most common clinical impact of CPIs was improving efficacy in 45% of the interventions, followed by preventing unnecessary exposure to the antimicrobials in around 30% of the interventions. The interventions were of major significance in 64% of the cases. This translated into a projected net cost saving of approximately $200,000 USD/year. CONCLUSIONS: CPs interventions on antimicrobial use had a positive impact on both the clinical and financial outcomes.