Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026
Assessing the impact of antimicrobial stewardship in low-income healthcare settings: a study of antibiotic use and antimicrobial susceptibility patterns in Indian hospitals.
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Vasave Ulhas, Paroha Amit
Аннотация
OBJECTIVE: The rising incidence of antimicrobial resistance (AMR) underscores the urgent need for effective antimicrobial stewardship (AMS). This study assessed the impact of a tailored AMS initiative in Indian hospitals.
METHODS: An AMS surveillance program was implemented across 11 Indian hospitals (January 2022-June 2023). The intervention (July 2022-June 2023) included hospital-specific antibiograms, antibiotic policy design and implementation, monitoring antibiotic consumption, and tracking multidrug-resistant organisms (MDROs). Hospital staff were trained, and compliance audits with feedback were conducted. Implementation followed the Model for Improvement methodology over 18 months.
RESULTS: AMS surveillance revealed significant improvement in AMS knowledge and practices from the baseline to the postintervention phase. Antibiotic compliance increased from a baseline of 10% to 71% across hospitals, reaching 73%-91% in the subsequent period. Surgical prophylaxis compliance improved substantially, particularly in hospitals with initially low adherence. Optimizations in antibiotic selection, dosing, duration, intravenous-to-oral switching, and de-escalation were also observed, resulting in significant compliance gains across all domains. Use of antibiotics classified by the World Health Organization as safer first-line options with a narrow spectrum increased, while use of second- and third-line antibiotics, including those with broader spectra and higher resistance risks, decreased, reflecting a shift toward safer prescribing practices. However, MDRO incidence rates remained variable across sites, showing room for improvement.
CONCLUSION: Locally tailored AMS interventions within a structured quality improvement framework can establish sustainable practices to mitigate AMR. These findings demonstrate effective strategies for optimizing antibiotic use and provide valuable insights for broader implementation of AMS.
METHODS: An AMS surveillance program was implemented across 11 Indian hospitals (January 2022-June 2023). The intervention (July 2022-June 2023) included hospital-specific antibiograms, antibiotic policy design and implementation, monitoring antibiotic consumption, and tracking multidrug-resistant organisms (MDROs). Hospital staff were trained, and compliance audits with feedback were conducted. Implementation followed the Model for Improvement methodology over 18 months.
RESULTS: AMS surveillance revealed significant improvement in AMS knowledge and practices from the baseline to the postintervention phase. Antibiotic compliance increased from a baseline of 10% to 71% across hospitals, reaching 73%-91% in the subsequent period. Surgical prophylaxis compliance improved substantially, particularly in hospitals with initially low adherence. Optimizations in antibiotic selection, dosing, duration, intravenous-to-oral switching, and de-escalation were also observed, resulting in significant compliance gains across all domains. Use of antibiotics classified by the World Health Organization as safer first-line options with a narrow spectrum increased, while use of second- and third-line antibiotics, including those with broader spectra and higher resistance risks, decreased, reflecting a shift toward safer prescribing practices. However, MDRO incidence rates remained variable across sites, showing room for improvement.
CONCLUSION: Locally tailored AMS interventions within a structured quality improvement framework can establish sustainable practices to mitigate AMR. These findings demonstrate effective strategies for optimizing antibiotic use and provide valuable insights for broader implementation of AMS.