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Cited by 68Antibiotic Use and ResistancePharmaceutical Practices and Patient OutcomesAntibiotic Resistance in Bacteria

Implementation and impact of an antimicrobial stewardship program at a tertiary care center in south India

Open access
Singh, Sanjeev, Menon, Vidya P, Mohamed, Zubair U, Kumar, V Anil, Nampoothiri, Vrinda, Sudhir, Sangita, Moni, Merlin, Dipu, T S +5 more·2019·Open Forum Infectious Diseases
DOI 10.1093/ofid/ofy290PMC PMC6475722
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Abstract

BACKGROUND: Antimicrobial resistance is a major public health threat internationally but, particularly in India. A primary contributing factor to this rise in resistance includes unregulated access to antimicrobials. Implementing antimicrobial stewardship programs (ASPs) in the acute hospital setting will help curb inappropriate antibiotic use in India. Currently, ASPs are rare in India but are gaining momentum. This study describes ASP implementation in a large, academic, private, tertiary care center in India. METHODS: An ASP was established in February 2016 consisting of an administrative champion, hospitalist, microbiologist, intensivist, and pharmacists. Antimicrobial stewardship program interventions included postprescriptive audit and establishment of institutional guidelines. The ASP tracked appropriate drug selection including loading dose, maintenance dose, frequency, route, duration of therapy, de-escalation, and compliance with ASP recommendations. Defined daily dose (DDD) of drugs and cost of antimicrobials were compared between the pre-implementation phase (February 2015-January 2016) and post-implementation phase (February 2016-January 2017). RESULTS: Of 48 555 patients admitted during the post-implementation phase, 1020 received 1326 prescriptions for restricted antibiotics. Antibiotic therapy was appropriate in 56% (742) of the total patient prescriptions. A total of 2776 instances of "inappropriate" antimicrobial prescriptions were intervened upon by the ASP. Duration (806, 29%) was the most common reason for inappropriate therapy. Compliance with ASP recommendations was 54% (318). For all major restricted drugs, the DDD/1000 patient days declined, and there was a significant reduction in mean monthly cost by 14.4% in the post-implementation phase. CONCLUSIONS: Implementation of a multidisciplinary antibiotic stewardship program in this academic, large, Indian hospital demonstrated feasibility and economic benefits.

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  • While the composition of the IPC and AMS teams varies across different settings, emerging studies from LMICs support multidisciplinary AMS teams in general, as well as being specific to paediatric departments.

    “While the composition of the IPC and AMS teams varies across different settings, emerging studies from LMICs support multidisciplinary AMS teams in general, as well as being specific to paediatric departments.5,28,30–33”

    From Rationalizing irrational prescribing—infection-related attitudes and practices across paediatric surgery specialties in a hospital in South India (2024) · cites this paper as [5]

    The Conclusions (page unavailable) report successful implementation of a multidisciplinary antimicrobial stewardship team at a South Indian hospital. The Results report 65% compliance with stewardship recommendations in pediatrics, but the study did not evaluate a team specific to a paediatric department or variation in IPC and AMS team composition across settings. (LLM, conf=0.85)

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  1. [35]Nain VK, Khurana GS, Singh S, et al Antibiotic resistance pattern in bacterial isolates obtained from different water samples of Delhi region. DU J Undergrad Res Innov 2015; 1: 219– 27.

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Authors
Singh, S., Menon, V. P., Mohamed, Z. U., Kumar, V. A., Nampoothiri, V., Sudhir, S., Moni, M., Dipu, T. S., Dutt, A., Edathadathil, F., Keerthivasan, G., Kaye, K. S., & Patel, P. K.
Affiliations
  • Amrita Institute of Medical Sciences and Research Centre (IN)
  • Department of Internal Medicine, Amrita Institute of Medical Sciences, Kochi, India
  • Michigan Medicine (US)
  • VA Ann Arbor Healthcare System (US)
Corresponding author
Menon, Vidya P
ORCID
Venue
Open Forum Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
2018-11-08
Volume
6
Issue
4
Pages
ofy290-ofy290
ISSN
2328-8957 (ISSN-L)
DOI
10.1093/ofid/ofy290
PMC
PMC6475722
OpenAlex
W2900347100
Cited by
68
References
37
Citations by year
2026: 9 · 2025: 10 · 2024: 7 · 2023: 6 · 2022: 7 · 2021: 15 · 2020: 9 · 2019: 3 · 2017: 2
FWCI
4.15
Type
journal article
Language
en
Open access
Licence
Locations
  • Open Forum Infectious Diseases (publishedVersion, cc-by-nc-nd)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
Keywords
antimicrobial stewardship programs, antimicrobial resistance, inappropriate antibiotic prescribing, defined daily doses, multidisciplinary team, antibiotic duration, de-escalation, tertiary care hospital, India

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