Hospital-based antimicrobial stewardship, India

Abstract

Objective To establish a framework for implementing antimicrobial stewardship in Indian tertiary care hospitals, and identify challenges and enablers for implementation. Methods Over 2018–2021 the Indian Council of Medical Research followed a systematic approach to establish a framework for implementation of antimicrobial stewardship in Indian hospitals. We selected 20 Indian tertiary care hospitals to study the feasibility of implementing a stewardship programme. Based on a questionnaire to lead physicians before and after the intervention, we assessed progress using a set of process and outcome indicators. In a qualitative survey we identified enablers and barriers to implementation of antimicrobial stewardship. Findings We found an improvement in various antimicrobial stewardship implementation indicators in the hospitals after the intervention. All 20 hospitals conducted monthly point prevalence analysis of cultures compared with three hospitals before the intervention. The number of hospitals that initiated formulary restrictions increased from two to 12 hospitals and the number of hospitals that started practising prescription audit and feedback increased from six to 16 hospitals. Respondents in 15 hospitals expressed their willingness to expand the coverage of antimicrobial stewardship implementation to other wards and intensive care units. Six hospitals were willing to recruit the permanent staff needed for antimicrobial stewardship activities. Conclusion Antimicrobial stewardship can be implemented in Indian tertiary hospitals with reasonable success, subject to institutional support, availability of trained manpower and willingness of hospitals to support antimicrobial stewardship-related educational and training activities.

Prevalence of vancomycin-resistant Enterococci in India between 2000 and 2022: a systematic review and meta-analysis

“…However, this study excluded all patients taking oral vancomycin thus making the calculation of unsuitable vancomycin usage a likely misestimation; though it is uncertain whether the result is an under- or overestimation. Despite this, India does not currently have a national-level antimicrobial stewardship plan [ 44 ]. Antimicrobial stewardship programs have demonstrated the ability to lower both antibiotic consumption and resistance; consequently, this has become a key strategy used to tackle AMR elsewhere [ 45 ].…”

A systematic synthesis of expert opinion on effective policies to tackle bacterial resistance worldwide

“…The antimicrobial stewardship interventions, which were introduced in 2019 in India (Walia et al., 2019 ), were used to monitor the progress and implementation of the stewardship program in India between 2019 and 2021. The results indicated that the majority of tertiary hospitals implemented antimicrobial stewardship programs in their hospitals with the help of funding and capacity‐building activities from the Indian Council of Medical Research (Vijay et al., 2023 ). Another study used this policy document (Walia et al., 2019 ) to identify antibiotic prescription patterns after the decline of a major COVID‐19 wave at a dedicated COVID‐19 hospital in India.…”

Pre- and Post-COVID-19 Appraisal of Antimicrobial Susceptibility for Urinary Tract Infections at an Outpatient Setting of a Tertiary Care Hospital in Delhi

“…There are several studies evaluating the impact of the pandemic on UTI and antimicrobial resistance [9][10][11]. With increased awareness about antimicrobial stewardship, most hospitals are shifting to the rational use of antibiotics and updating their antibiogram periodically [12]. But, in community settings, there is still a long way to go [13].…”