Original Article

A Questionnaire Based Study to Assess the Antimicrobial Stewardship Practices in the Tertiary Care Hospitals in India

Abstract

Background: Due to emergence of antimicrobial-resistant healthcare associated infections (HAIs), the implementation of antimicrobial stewardship programs (AMSP) is the need of hour at institutional and national levels. We conducted an assessment of the current status of infrastructure, manpower, and education and training (E&T) in relation to Antimicrobial Stewardship (AMS) in the tertiary care hospitals of India. Methods: Healthcare professionals from 30 tertiary care hospitals in North-western India (public & private) were invited to participate in online survey from Nov 2022 to Apr 2023 by sending a pre-designed questionnaire about the current existing antimicrobial stewardship (AMS) practices at their hospitals through email. The answers received on various parameters of AMS were analyzed using descriptive statistics. Results: 72 healthcare professionals from 30 hospitals responded to the survey. 63% of the respondents had received education and training (E&T) on AMS during undergraduate or postgraduate training. 65% had not received any E&T at induction to the hospital. The positive responses were 36%, 47% and 33% for leadership support, accountability and availability of drug expertise in form of pharmacologist/pharmacist respectively. A policy to support optimal antibiotic use was present in 25% of respondents. Broad interventions to improve antibiotic use were scored as 28%, 7% and 6% for antibiotic time out, pre-authorization and prospective audit with feedback respectively. Conclusion: The findings reveal the enablers and barriers to implementation of antimicrobial stewardship and highlighted the need for establishing a framework for stricter implementation and monitoring of antimicrobial stewardship in Indian tertiary care hospitals. Few key areas which require immediate attention are: need for government level endorsement and leadership support of antimicrobial stewardship (AMS) activities; lack of AMS programs in hospitals; and lack of undergraduate/ postgraduate/at induction education and training in AMS for staff.

1. Karam G, Chastre J, Wilcox MH, Vincent JL. Antibiotic strategies in the era of multidrug resistance. Crit Care. 2016;20(1):136.
2. WHO Collaborating Centre for Drug Statistics Methodology, Guidelines for ATC classification and DDD assignment 2013. Oslo, 2013. ISBN 978-82-8082-525-4. Available at https://www.whocc.no/filearchive/publications/1_2013guidelines.pdf. [Last accessed on 2022 May 27]
3. Gilbert DN, Chambers HF, Eliopoulos GM, et al: Editors. The Sanford guide to antimicrobial chemotherapy, 46 th Ed. Antimicrobial Chemotherapy Inc., Sperryville, VA, 2016. ISBN 978-1-930808-93-5.
4. Balaji V, Rupali P, Walia K, Ohri V. Antimicrobial Stewardship Program Guidelines; 2018. Available from: https://www.icmr.nic.in/sites/default/files/guidelines/AMSP.pdf. [Last accessed on 2022 May 27]
5. CDC. Core Elements of Hospital Antibiotic Stewardship Programs. Atlanta, GA: US Department of Health and Human Services, CDC; 2014. Available at http://www.cdc.gov/ getsmart/healthcare/implementation/core-elements.html. [Last accessed on 2022 May 27]
6. Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45(3):486-552.
7. Society of Critical Care Medicine. Updated Bundles in Response to New Evidence. Surviving sepsis campaign. 2016. Available at http://www.survivingsepsis.org/SiteCollectionDocuments /SSC_Bundle.pdf. [Last accessed on 2022 May 27]
8. Buising KL, Thursky KA, Robertson MB, et al. Electronic antibiotic stewardship reduced consumption of broad-spectrum antibiotics using a computerized antimicrobial approval system in a hospital setting. J Antimicrob Chemother. 2008; 62:608–16.
9. Dellit TH, Owens RC, McGowan JE Jr, et al. Infectious Diseases Society of America; Society for Healthcare Epidemiology of America. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44(2):159-77.
10. World Health Organization. Interventions and strategies to improve the use of antimicrobials in developing countries: A review. Available from: http://www.whq libdoc.who.int/hq/2001/ who_CDS_CSR_DRS_2001.9.pdf. [Last accessed on 2022 Mar 20].
11. Reddaiah VP, Kapoor SK. Effectiveness of ARI control strategy on under five mortality. Indian J Pediatr, 1991; 58:123-30.
12. WHO. Antimicrobial resistance: Global report on surveillance. Geneva: World Health Organization; 2014. Available at: http://apps.who.int/iris/bitstream/10665/112642/1/ 9789241564748_eng.pdf. [Last accessed on 2022 May 23]
13. Doron S, Davidson LE. Antimicrobial stewardship. Mayo Clin Proc. 2011; 86:1113-23.
14. Pestotnik SL, Classen DC, Evans RS, Burke JP. Implementing antibiotic practice guidelines through computer-assisted decision support: Clinical and financial outcomes. Ann Intern Med. 1996;124:884-90.
15. Kumar A, Sahu M, Sahoo PR, Wig N. Under-explored dimensions of anti-microbial stewardship in India. J Assoc Physicians India 2018;66:69-71.
16. Gelband H, Miller-Petrie M, Pant S, et al. The state of the world’s antibiotics, 2015. Washington DC: Center for Disease Dynamics, Economics & Policy; 2015. http://cddep.org/publications/state_worlds_antibiotics_2015 (accessed May 21, 2022).
17. Van Boeckel TP, Gandra SAA, Caudron Q, Grenfell BT, Levin SA, Laxminarayan R. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lancet Infect Dis. 2014;14(8):742e50
18. Akpan MR, Ahmad R, Shebl NA, Ashiru-Oredope D. A review of quality measures for assessing the impact of antimicrobial stewardship programs in hospitals. Antibiotics (Basel). 2016;5(1). pii: E5.
19. Howard P, Pulcini C, Levy Hara G, West RM, Gould IM, Harbarth S, Nathwani D. ESCMID Study Group for Antimicrobial Policies (ESGAP); ISC Group on Antimicrobial Stewardship. An international cross-sectional survey of antimicrobial stewardship programmes in hospitals. J Antimicrob Chemother. 2015;70(4):1245-55.
20. White AC Jr, Atmar RL, Wilson J, et al. Effects of requiring prior authorization for selected antimicrobials: expenditures, susceptibilities, and clinical outcomes. Clin Infect Dis. 1997; 25:230-9.
21. Pakyz AL, Oinonen M, Polk RE. Relationship of carbapenem restriction in 22 university teaching hospitals to carbapenem use and carbapenem-resistant Pseudomonas aeruginosa. Antimicrob Agents Chemother. 2009; 53:1983-6.
22. Metjian TA, Prasad PA, Kogon A, et al. Evaluation of an antimicrobial stewardship program at a pediatric teaching hospital. Pediatr Infect Dis J. 2008; 27:106-11.
Files
IssueVol 11, No 3 (Summer 2023) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jpc.v11i3.15995
Keywords
Antimicrobial Stewardship; Tertiary care; Antimicrobial resistance.
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Mishra P, Dhillon H, Vihan S, Bhargava S. A Questionnaire Based Study to Assess the Antimicrobial Stewardship Practices in the Tertiary Care Hospitals in India. J Pharm Care. 2023;11(3):126-134.