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Antimicrobial stewardship programme in a trauma centre of a tertiary care hospital in North India: Effects and
Madhur Verma1, Nusrat Shafiq2, Jaya Prasad Tripathy3
1Department of Community Medicine, Kalpana Chawla Government Medical College, Karnal, Haryana, India; Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Implementing an antimicrobial stewardship program (ASP) in an Indian tertiary trauma center significantly improved antimicrobial prescribing. Challenges included a lack of electronic systems and doctor training, but the ASP model shows promise for wider adoption.
Area of Science:
- Healthcare Management
- Infectious Disease Control
- Clinical Pharmacy
Background:
- Hospital-based antimicrobial stewardship programs (ASPs) are crucial for optimizing antimicrobial use through coordinated interventions.
- This study focuses on the implementation of an ASP in a tertiary trauma care center in India.
- Evaluating the challenges and impact of ASPs is vital for improving antimicrobial prescription patterns.
Purpose of the Study:
- To evaluate the implementation challenges of an antimicrobial stewardship program (ASP) in a tertiary trauma care center in India.
- To assess the effect of the ASP on antimicrobial prescription appropriateness.
- To identify key challenges and propose solutions for successful ASP implementation.
Main Methods:
- A pre- and post-intervention study design was employed to compare antimicrobial prescription patterns.
- The appropriateness of antimicrobial prescriptions (dose, route, duration, indication, choice) was assessed using a validated algorithm.
- ASP interventions included daily audit and feedback, restricted antibacterial use, bedside reviews, and educational activities.
Main Results:
- Antimicrobial stewardship program implementation led to a significant decrease in prophylactic antimicrobial use by 11%.
- Prescription patterns showed significant improvements in duration (8%), choice (14%), indication (2%), and route (8%) during the intervention phase.
- Patients in the intervention group had a higher likelihood of receiving appropriate antimicrobial duration (aOR=2.1) and indication (aOR=2.4).
Conclusions:
- The implemented antimicrobial stewardship program demonstrated significant improvements in antimicrobial usage patterns.
- Key implementation challenges included the absence of electronic recording systems and inadequate orientation of doctors on rational antimicrobial use.
- The study suggests that this ASP model can be replicated in other hospital settings to promote rational antimicrobial use.
Objectives:
Hospital-based antimicrobial stewardship programmes (ASPs) aim to optimise antimicrobial use by employing a set of co-ordinated interventions. This study evaluated the implementation challenges of an ASP in a tertiary trauma care centre in India and its effect on antimicrobial prescription.
Methods:
A pre- and post-intervention study design was used to compare the effects of the ASP amongst patients admitted during November 2017-January 2018. The appropriateness of antimicrobial prescriptions (dose, route, duration, indication, choice) was evaluated using a validated algorithm. ASP interventions involved daily audit and feedback, restriction on antibacterial usage, daily bedside review, education, and sensitisation activities for residents/nurses. Key implementation challenges and solutions were brainstormed in weekly meetings.
Results:
A total of 695 patients were prescribed 1331 antimicrobials. There was a decrease in prophylactic antimicrobial use by 11% (P < 0.001). The prescription pattern improved significantly in the intervention phase compared with the pre-intervention phase in terms of duration, choice, indication and route of administration by 8%, 14%, 2% and 8% respectively. Patients in the intervention arm had significantly higher likelihood of receiving antimicrobials for an appropriate duration (aOR = 2.1, 95% CI 1.3-3.6; P = 0.004) and reason (aOR = 2.4, 95% CI 1.3-4.3; P = 0.003). Challenges identified in implementation included absence of an electronic recording system and inadequate orientation of treating doctors regarding rational antimicrobial use.
Conclusions:
The ASP demonstrated significant improvement in antimicrobial usage. This model may be replicated in other hospital settings to promote rational use of antimicrobials.
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