Decreasing antibiotic over-use by implementation of an antibiotic stewardship programme in preterm neonates in resource limited settings – a quality improvement initiative

Kommalur, Anitha; Baddadka, Vidyalakshmi; Devadas, Sahana; Kariyappa, Mallesh; Dakshayani, B; Lakshminarayana, Shilpa Krishnapura; Rao, Suman; Venkatagiri, Praveen; Chinnappa, Gayathri Devi; Sajjan, Sushma Veranna

doi:10.1080/20469047.2021.1886545

Cited by 6 publications

(2 citation statements)

References 18 publications

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“…The World Health Organisation (WHO) has declared antimicrobial resistance (AMR) as one of the top ten global health threats ( WHO, 2020 ; Miller-Petrie and Gelband, 2017 ). Much of the current literature on addressing AMR in LMICs has focused on antibiotic stewardship, defined as interventions that seek to measure and optimise the use of antibiotics; however, the predominant focus is on inpatient settings, where antibiotic stewardship committees can be readily established and compliance can be monitored ( Van Dijck et al, 2018 ; Davey et al, 2013 ; Baubie et al, 2019 ; Schuts et al, 2016 ; McKnight et al, 2019 ; Kommalur et al, 2021 ; Bhalla et al, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

Perceptions of effective policy interventions and strategies to address antibiotic misuse within primary healthcare in India: A qualitative study

Nair

Engel

Zeegers

et al. 2023

Journal of Infection Prevention

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Objectives Antimicrobial resistance poses a major public health threat. Despite Indian retail sector antibiotic consumption per capita increasing by approximately 22% between 2008 and 2016, empirical studies that examine policy or behavioural interventions addressing antibiotic misuse in primary healthcare are scarce. Our study aimed to assess perceptions of interventions and gaps in policy and practice with respect to outpatient antibiotic misuse in India. Methods We conducted 23 semi-structured, in-depth interviews with a variety of key informants with diverse backgrounds in academia, non-government organisations, policy, advocacy, pharmacy, medicine and others. Data were charted into a framework matrix and analysed using a hybrid, inductive and deductive thematic analysis. Themes were analysed and organised according to the socio-ecological model at various levels ranging from the individual to the enabling environment. Results Key informants largely focused on the importance of adopting a structural perspective to addressing socio-ecological drivers of antibiotic misuse. There was a recognition that educational interventions targeting individual or interpersonal interactions were largely ineffective, and policy interventions should incorporate behavioural nudge interventions, improve the healthcare infrastructure and embrace task shifting to rectify staffing disparities in rural areas. Conclusions Prescription behaviour is perceived to be governed by structural issues of access and limitations in public health infrastructure that create an enabling environment for antibiotic overuse. Interventions should move beyond a clinical and individual focus on behaviour change with respect to antimicrobial resistance and aim for structural alignment between existing disease specific programs and between the informal and formal sector of healthcare delivery in India.

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Section: Introductionmentioning

confidence: 99%

Perceptions of effective policy interventions and strategies to address antibiotic misuse within primary healthcare in India: A qualitative study

Nair

Engel

Zeegers

et al. 2023

Journal of Infection Prevention

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“…Therefore, antibiotic overexposure may lead to unavoidable effects on VLBW infants, especially in infants without confirmed infection. However, data are scarcely reported on the association between antibiotic exposure and adverse outcomes in developing countries that have a high burden of antibiotic consumption [ 5 ]. The present study aimed to explore the current status of antibiotic use in VLBW infants among multicenters in China and to further assess the association between a higher antibiotic use rate (AUR) and short-term outcomes in VLBW infants without culture-proven sepsis or NEC to provide basic evidence for urging antimicrobial stewardship (ASP) in VLBW infants in China.…”

Section: Introductionmentioning

confidence: 99%

Association Between Antibiotic Overexposure and Adverse Outcomes in Very-Low-Birth-Weight Infants Without Culture-Proven Sepsis or Necrotizing Enterocolitis: A Multicenter Prospective Study

Hou

et al. 2022

Indian J Pediatr

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Objectives To explore the associations between higher antibiotic use rates (AURs) and adverse outcomes in very-low-birth-weight (VLBW) infants without culture-proven sepsis or necrotizing enterocolitis (NEC) in a multicenter of China. Methods A prospective cohort study was performed on VLBW infants admitted to 24 neonatal intensive care units from January 1, 2018, to December 31, 2018. AUR was calculated as calendar days of antibiotic therapy divided by total hospital days. The composite primary outcome was defined as mortality or severe morbidity, including any of the following: severe neurologic injury, bronchopulmonary dysplasia (BPD), and stage 3 or higher retinopathy of prematurity. Results A total of 1,034 VLBW infants who received antibiotics without culture-proven sepsis or NEC were included in this study. The overall AUR of eligible VLBW infants was 55%, and the AUR of each eligible VLBW infant ranged from 3 to 100%, with a median of 56% (IQR 33%, 86%). After generalized propensity score and logistic regression analysis of 4 groups of VLBW infants with different AUR range, infants in the higher quartile AUR, (Q3, 0.57~0.86) and (Q4, 0.87~1.00), had higher odds of composite primary outcome (adjusted OR: 1.81; 95% CI: 1.23–2.67; adjusted OR 2.37; 95% CI: 1.59–3.54, respectively) and BPD (adjusted OR: 3.09; 95% CI: 1.52–6.57; adjusted OR 3.17; 95% CI: 1.56–6.57, respectively) than those in the lowest AUR (Q1). Conclusions Antibiotic overexposure in VLBW infants without culture-proven sepsis or NEC was associated with increased risk of composite primary outcome and BPD. Rational empirical antibiotic use in VLBW infants is urgently needed in China.

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Feasibility, Sustainability, and Effectiveness of the Implementation of “Facility-Team-Driven” Approach for Improving the Quality of Newborn Care in South India

Venugopal,

Patil,

Thukral

et al. 2023

Indian J Pediatr

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Decreasing antibiotic over-use by implementation of an antibiotic stewardship programme in preterm neonates in resource limited settings – a quality improvement initiative

Cited by 6 publications

References 18 publications

Perceptions of effective policy interventions and strategies to address antibiotic misuse within primary healthcare in India: A qualitative study

Perceptions of effective policy interventions and strategies to address antibiotic misuse within primary healthcare in India: A qualitative study

Association Between Antibiotic Overexposure and Adverse Outcomes in Very-Low-Birth-Weight Infants Without Culture-Proven Sepsis or Necrotizing Enterocolitis: A Multicenter Prospective Study

Feasibility, Sustainability, and Effectiveness of the Implementation of “Facility-Team-Driven” Approach for Improving the Quality of Newborn Care in South India

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