Assessment of Core Capacities for Antimicrobial Stewardship Practices in Indian Hospitals: Report from a Multicentric Initiative of Global Health Security Agenda

Mathur, Purva; Guleria, Randeep; Malhotra, Rajesh; Mahesh, C; Gupta, Sunil; Kumar, Subodh; Sagar, Sushma; Wig, Naveet; Garg, Priyanka; Kapil, Arti; Khurana, Surbhi; Katoch, Omika; Katyal, Sonal; Manoj, Sahu; Chakrabarti, Arunaloke; Ray, Pallab; Biswal, Manisha; Taneja, Neelam; Rupali, Priscilla; Subaramani, K; Ebor, Jacob; Veeraraghavan, Balaji; Rodrigues, Camilla; Vijayalakshmi, N.; Tak, Vibhor; Kuldeep, Singh; Pradeep, K.Bhatia; Neeraj, Gupta; Daisy, Khera; Vimala, Venkatesh; Mukhopadhyay, Chiranjay; Vandana, KE; Varma, Muralidhar; Deotale, Vijayshri; Ruchita, Attal; Padmaja, Kanne; S, Sukanya; Wattal, Chand; Goel, Neeraj; Bhattacharya, Sanjay; Sen, Sourav; Karuna, Tadepalli; Saigal, Sanjiv; Behera, Bijayini; Singh, Sanjeev; Thirunarayan, M A; Nath, Reema; Lahri, Saikia; Raja, R.; Hirak, J Raj; Baveja, Sujata; Desma, D’Souza; Chandy, Mammen; Mukherjee, Sudipta Kumer; Manas, K Roy; Goel, Gaurav; Swagata, Tripathy; Satyajeet, Misra; Anupam, Dey; Tushar, S Mishra; Bashir, Amreen; Bashir, Gulnaz; Nazir, Shaista; Sulochana, Devi; Khuraijam, R Devi; Langpoklakpam, C Singh; Das, Padma; Bhargava, Anudita; Ujjwala, Gaikwad; Khandelwal, Neeta; Geeta, Vaghela; Tanvi, Sukharamwala; Shristi, Jain; Verma, Prachi; Mamta, Lamba; Bhattacharyya, Prithwis; Anil, C Phukan; Clarissa, Lyngdoh; Gaind, Rajni; Rushika, Saksena; Kapoor, Lata; Vinod, Ohri; Walia, Kāmini

doi:10.4103/ijmm.ijmm_19_445

Cited by 6 publications

(8 citation statements)

References 27 publications

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“…For example, concise guidelines that clearly outlined the appropriate antibiotics for common infections and interactive training sessions were reported to be more receptive by prescribers. Furthermore, six studies reported that poorly designed interventions (such as lack of details in guidelines for antibiotic prescription and insufficient implementation time) or using ineffective approaches to deliver them (such as the development of guidelines without dissemination strategies) were barriers to achieving intended behavior change outcomes [ 36 , 46 , 50 , 62 – 64 ].…”

Section: Resultsmentioning

confidence: 99%

“…Specifically, 12 studies found that it was difficult to promote appropriate behavior among prescribers and users in countries without national policies or guidelines for antibiotic use or those with weak enforcement of existing regulations [ 39 , 40 , 43 , 48 , 52 , 63 , 67 – 72 ]. In contrast, interventions that were developed in line with national AMR initiatives and the availability of national policies and guidelines facilitated the implementation of interventions to improve rational antibiotic use [ 38 , 40 , 46 , 48 , 52 , 68 , 70 , 73 – 75 ].…”

Section: Resultsmentioning

confidence: 99%

“…A total of 30 studies reported barriers and facilitators in the structural characteristics construct, which refers to the organizational environment where interventions are conducted. Infrastructure constraints included insufficient laboratory capacity to provide data on AMR patterns and diagnostic results timely, lack of data management technology for auditing antimicrobial stewardship activities, lack of in-hospital pharmacies, and inadequate supply of high-quality and effective antibiotics [ 37 , 39 – 41 , 43 , 44 , 46 – 48 , 52 , 66 – 70 , 73 , 74 , 76 – 78 ]. Furthermore, several studies reported that health facilities in LMICs did not have an established governance structure to lead antimicrobial stewardship programs [ 46 , 48 , 63 , 67 ], and that high turnover of medical staff and bureaucracy within hospitals prevented the successful implementation of antimicrobial stewardship programs [ 40 , 68 ].…”

Section: Resultsmentioning

confidence: 99%

“…Infrastructure constraints included insufficient laboratory capacity to provide data on AMR patterns and diagnostic results timely, lack of data management technology for auditing antimicrobial stewardship activities, lack of in-hospital pharmacies, and inadequate supply of high-quality and effective antibiotics [ 37 , 39 – 41 , 43 , 44 , 46 – 48 , 52 , 66 – 70 , 73 , 74 , 76 – 78 ]. Furthermore, several studies reported that health facilities in LMICs did not have an established governance structure to lead antimicrobial stewardship programs [ 46 , 48 , 63 , 67 ], and that high turnover of medical staff and bureaucracy within hospitals prevented the successful implementation of antimicrobial stewardship programs [ 40 , 68 ]. On the contrary, improving the infrastructure of facilities where interventions were conducted, such as establishing microbiology laboratories and enhancing the supply of antibiotics, facilitated prescribers to make evidence-based decisions on treating patients with appropriate antibiotics [ 36 , 43 , 48 , 50 , 56 , 60 , 62 , 68 ].…”

Section: Resultsmentioning

confidence: 99%

“…In 21 studies, the involvement and support of higher-level stakeholders (such as officials from the Ministry of Health, health authorities, experts, leaders in health facilities) and administrative staff were reported as a common facilitator for the successful implementation of behavior change interventions [ 37 , 39 , 40 , 44 , 48 – 50 , 52 , 54 , 56 , 58 , 59 , 62 , 65 , 70 , 78 – 83 ]. The lack thereof had been documented to impede intervention implementation in seven studies [ 43 , 46 , 60 , 63 , 69 , 71 , 84 ].…”

Section: Resultsmentioning

confidence: 99%

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Barriers and facilitators of implementing interventions to improve appropriate antibiotic use in low- and middle-income countries: a systematic review based on the Consolidated Framework for Implementation Research

Tannous

Haldane

et al. 2022

Implementation Sci

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Background Behavior change interventions that aim to improve rational antibiotic use in prescribers and users have been widely conducted in both high- and LMICs. However, currently, no review has systematically examined challenges unique to LMICs and offered insights into the underlying contextual factors that influence these interventions. We adopted an implementation research perspective to systematically synthesize the implementation barriers and facilitators in LMICs. Methods We conducted literature searches in five electronic databases and identified studies that involved the implementation of behavior change interventions to improve appropriate antibiotic use in prescribers and users in LMICs and reported implementation barriers and facilitators. Behavior change interventions were defined using the behavior change wheel, and the coding and synthesis of barriers and facilitators were guided by the Consolidated Framework for Implementation Research (CFIR). Results We identified 52 eligible studies, with the majority targeting prescribers practicing at tertiary facilities (N=39, 75%). The most commonly reported factors influencing implementation were found in the inner setting domain of the CFIR framework, particularly related to constraints in resources and the infrastructure of the facilities where interventions were implemented. Barriers related to the external policy environment (e.g., lack of national initiatives and policies on antibiotic use), and individual characteristics of target populations (e.g., reluctance to change prescribing behaviors) were also common, as well as facilitators related to intervention characteristics (e.g., embedding interventions in routine practice) and process (e.g., stakeholder engagement). We also provided insights into the interrelationships between these factors and the underlying causes contributing to the implementation challenges in LMICs. Conclusion We presented a comprehensive overview of the barriers and facilitators of implementing behavior change interventions to promote rational antibiotic use in LMICs. Our findings suggest that facilitating the implementation of interventions to improve rational antibiotic use needs comprehensive efforts to address challenges at policy, organizational, and implementation levels. Specific strategies include (1) strengthening political commitment to prompt mobilization of domestic resources and formulation of a sustainable national strategy on AMR, (2) improving the infrastructure of health facilities that allow prescribers to make evidence-based clinical decisions, and (3) engaging local stakeholders to improve their buy-in and facilitate contextualizing interventions. Trial registration PROSPERO: CRD42021252715.

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Section: Resultsmentioning

confidence: 99%