Impact of an antimicrobial stewardship intervention in India: Evaluation of post-prescription review and feedback as a method of promoting optimal antimicrobial use in the intensive care units of a tertiary-care hospital

Abstract

Objective:Antimicrobial stewardship programs (ASPs) are effective in developed countries. In this study, we assessed the effectiveness of an infectious disease (ID) physician–driven post-prescription review and feedback as an ASP strategy in India, a low middle-income country (LMIC).Design and setting:This prospective cohort study was carried out for 18 months in 2 intensive care units of a tertiary-care hospital, consisting of 3 phases: baseline, intervention, and follow up. Each phase spanned 6 months.Participants:Patients aged ≥15 years receiving 48 hours of study antibiotics were recruited for the study.Methods:During the intervention phase, an ID physician reviewed the included cases and gave alternate recommendations if the antibiotic use was inappropriate. Acceptance of the recommendations was measured after 48 hours. The primary outcome of the study was days of therapy (DOT) per 1,000 study patient days (PD).Results:Overall, 401 patients were recruited in the baseline phase, 381 patients were recruited in the intervention phase, and 379 patients were recruited in the follow-up phase. Antimicrobial use decreased from 831.5 during the baseline phase to 717 DOT per 1,000 PD in the intervention phase (P < .0001). The effect was sustained in the follow-up phase (713.6 DOT per 1,000 PD). De-escalation according to culture susceptibility improved significantly in the intervention phase versus the baseline phase (42.7% vs 23.6%; P < .0001). Overall, 73.3% of antibiotic prescriptions were inappropriate. Recommendations by the ID team were accepted in 60.7% of the cases.Conclusion:The ID physician–driven implementation of an ASP was successful in reducing antibiotic utilization in an acute-care setting in India.

Advocacy for Increased International Efforts for Antimicrobial Stewardship Actions in Low-and Middle-Income Countries on Behalf of Alliance for the Prudent Use of Antimicrobials (APUA), Under the Auspices of the International Society of Antimicrobial Chemotherapy (ISAC)

“…Five years after the launch of WHO global action plan, many who have worked in the field have the feeling that, although progress have been achieved (12,39,40), with remarkable success stories (41)(42)(43), the actions undertaken to optimize the use of antimicrobial agents do not match the challenges of emerging antimicrobial resistance in most countries (23). In addition, the durability of progress achieved in AMS requires sustained efforts, otherwise the benefits may be rapidly lost (30,43).…”

Evaluation of a Hospital-Based Post-Prescription Review and Feedback Pilot in Kathmandu, Nepal

“…The evaluation of the PPRF program followed similar procedures used in the United States and more recently in a pilot program in Vellore, India. 17 The evaluation provided both evidence of positive changes and need for further development of stewardship training to optimize antibiotic use in low-resource hospital settings. Data indicate that the program was most effective in the medicine ward.…”

Impact of the Audit and Intervention of Infectologists in the Use of Antimicrobials in Intensive Care Units

“…The excessive and long-term use of antimicrobials has led to an increase in the number of adverse events related to drugs, increased health care costs, and, mainly, exerted selective pressure, contributing to microbial resistance, threatening its therapeutic e cacy [1,4,[5][6][7][8][9].…”