Antimicrobial prescription patterns in tertiary care centres in India: a multicentric point prevalence survey.

BACKGROUND

Antimicrobial resistance (AMR) poses a global health threat, emphasizing the need for Point Prevalence Surveys (PPS) to understand antibiotic use and resistance. This study assesses antibiotic use patterns and resistance in tertiary care hospitals across India to inform AMR interventions.

METHODS

This cross-sectional survey was conducted over two weeks between May and August 2023 in eight Indian tertiary care hospitals. The survey comprised two parts: the ward form, which captured ward details (name, specialty, bed count, and antibiotic use), and the patient form, which documented demographics, antimicrobial therapy, and microbiological data, including redundant coverage and designated antibiotics. Rationality was assessed using 50 forms from each site. Data were collected digitally by trained team of surveyors. The study included hospitalized patients on systemic antimicrobials, excluding outpatient, day-care dialysis patients, and those on topical antibiotics.

FINDINGS: Among 3974 patients in eight hospitals, adult surgical and pediatric medical wards had the highest antibiotic usage. Of 4248 prescriptions, the most common antibiotics were ceftriaxone (14.9%, 95% CI: 10.4%, 18.4%), metronidazole (10.2%, 95% CI: 6.0%-11.2%), amikacin (8.7%, 95% CI: 6.3%-11.3%), piperacillin/tazobactam (8.7%, 95% CI: 9.1%-10.5%), and meropenem (7.1%, 95% CI: 5.2%-9.5%). Antibiotics were categorized as 'Watch' (57.03%), 'Access' (32.67%), and 'Reserve' (5.08%). Primary indications were community-acquired infections (30.6%, 95% CI: 25.1%-32.5%) and surgical prophylaxis (31%, 95% CI: 29.8%-36.9%). HAIs prevalence was 13.3% (95% CI: 9.3%-15.4%), with majority of use being empiric (48.96%, 95% CI: 35.1%-58.8%). Common isolates included Escherichia coli, Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus. Assessment of rationale of antibiotic use was assessor dependent and variable (0-50% irrational prescriptions, majority due to prolonged duration of prophylaxis/treatment) across sites.

INTERPRETATION: The SASPI (Society of Antimicrobial Stewardship Practices in India)-led survey underscores the high use of antibiotics in the included tertiary care centers emphasizing the need for point prevalence surveys to guide antimicrobial stewardship programs. It highlights the importance of ongoing AMR surveillance, improved stewardship, and education to refine prescribing practices, targeting hospital-acquired infections, and reducing unnecessary treatments.

FUNDING: None.