Impact of an Anti-Microbial Stewardship Program on Targeted Antimicrobial Therapy in a Tertiary Care Health Care Institute in Central India

Abstract

IntroductionAntimicrobial resistance (AMR) has become a global pandemic. In order to identify this menace, World Health Organisation (WHO) has developed the Global Action Plan on AMR (GAP AMR). Antimicrobial stewardship programs (AMSP) have been identified as a decisive tool for combating AMR. One of the most efficient measures of these programs has been the implementation of point prevalence surveys (PPS) of antibiotic usage and subsequent audit feedback. The present study was undertaken to identify the impact of AMSP on curtailing of empirical usage of antibiotics and the augmentation of targeted therapy. MethodsIt is an observational, cross-sectional study comprising 1396 patients. The microbiology culture details and anti-microbial-sensitivity results were recorded. Antibiotic prescriptions were recorded in each patient during their hospital stay. ResultOut of 1396 patients treated over four quarters (Q1-Q4), 711 (50.9%) patients were on antibiotics, and among them, only 415 patients were subjected to any microbiological cultures with an overall bacterial culture rate (BCR) of 58.3%, and 296 patients (41.6%) were treated with antibiotics empirically without sending any samples for bacterial culture. There was a statistically significant rise in BCR from 47.3% in the first quarter to 77.6% in the fourth quarter. Sending specimens for blood culture increased significantly from 29.2% in Q1 to 37.6% in Q4. After receiving culture reports, 72.3% of cases continued with the same antibiotic, the antibiotic was changed in 19.9% of cases, and the antibiotic was stopped in 7.8% of cases. ConclusionThere was a strong positive impact of AMSP in curtailment of empirical usage of antibiotics and augmenting targeted therapy as evidenced by the significant rise in BCR over Q1-Q4 PPS as well as a significant rise in ordering for blood culture over the same time period.

Antibiotic point prevalence survey at a tertiary healthcare hospital in India: Identifying strategies to improve the antibiotic stewardship program immediately after a COVID-19 wave

“…However, PPSs conducted in neighbouring countries found prescribing rates of 100% in Bangladesh and 97.3% and 89.67% in Pakistan, far higher than at other times [ [23] , [24] , [25] ]. Our PPS, conducted immediately after a COVID-19 wave, found an antibiotic prescription rate of 41.73 %, which was much lower than the antibiotic prescription rates reported in regional PPSs conducted during a COVID-19 wave and was comparable to the antibiotic prescription rates reported in regional PPSs conducted prior to a COVID-19 wave [ 9 , 10 , [19] , [20] , [21] , [22] , [22] , [22] , [23] , [24] , [25] ]. In contrast to the developing nations of the Indian subcontinent, most developed nations of Europe and America had substantial lower antimicrobial prescription rates (25-34%) in the pre-COVID-19 period [ [26] , [27] , [28] ].…”

“…Another pre-COVID-19 wave PPS conducted in 16 private-sector hospitals in India reported an antibiotic prescription rate of 57.4% [ 10 ]. Another pre-COVID-19 wave PPS in a major tertiary care Indian hospital reported an antibiotic prescription rate of 50.9 % [ 19 ]. Even higher rates of antibiotic prescription were reported in pre-COVID-19 studies from neighbouring countries: 78% in Bangladesh, 77.16% in Pakistan, and 63.4% in Myanmar [ [20] , [21] , [22] ].…”

Point Prevalence Study (PPS) of Antibiotic Usage and Bacterial Culture Rate (BCR) among Secondary Care Hospitals of Small Cities in Central India: Consolidating Indian Evidence

“… 18 We have also documented in our earlier study that BCR improves significantly (47.3% to 77.6%) with the implementation of AMSP. 15 This study emphasizes the need for urgent AMSP implementation at secondary care hospitals in India.…”

“…We have earlier reported the baseline BCR in the same region but in a large tertiary care institute as 47.3%. 15 The BCR from various other countries has been documented as follows: China (40.16%), 16 Italy (61.2%), 17 and Switzerland (69%). 18 We have also documented in our earlier study that BCR improves significantly (47.3% to 77.6%) with the implementation of AMSP.…”

Barriers, facilitators, perceptions and impact of interventions in implementing antimicrobial stewardship programs in hospitals of low-middle and middle countries: a scoping review

“…ASPs brought about positive clinical outcomes in hospital inpatients in most cases. Microbiological outcomes to assess the impact of ASP were reported in 42% (22/53) of studies [ 63 , 65 , 66 , 71 , 76 , 79 , 81 – 85 , 87 – 89 , 100 , 101 , 109 , 110 ], including a decrease in the prevalence of multi-drug resistance bacterial strains like Acinetobacter spp , Methicillin-Resistant Staphylococcus aureus (MRSA) , Vancomycin-Resistant Enterococcus [VRE], increase in the antibiotic susceptibility of bacterial strains such as Pseudomonas aeruginosa, E. coli [ 71 , 81 , 82 , 85 ]. Studies also documented a reduction in the incidence of bacterial infections such as Clostridioides difficile infections and Candidemia [ 75 , 77 ], and a decrease in pan-drug resistant isolates [ 65 , 71 , 77 , 85 ].…”