Antimicrobial stewardship implementation in primary and secondary tier hospitals in India: interim findings from a...

Area of Science:

• Public Health
• Infectious Diseases
• Health Systems Research

Background:

• Antimicrobial stewardship programs (AMSP) are primarily in tertiary hospitals in India.
• Lower-tier hospitals are the initial point of patient contact, making them crucial for antibiotic use.
• Antimicrobial resistance (AMR) is a growing global health concern.

Purpose of the Study:

• To assess antibiotic and multiple antibiotic prescription rates (APR, MPR) in lower-tier Indian hospitals.
• To identify existing health system strengths for optimizing antibiotic prescribing.
• To inform the development of customized AMSPs for primary and secondary care settings.

Main Methods:

• A cross-sectional, convergent parallel mixed-method study was conducted in eight lower-tier hospitals in West Bengal, India.
• Quantitative analysis of 600 outpatient prescriptions for common infections (UTI, ARI, AUFI, ADD).
• Qualitative analysis of in-depth interviews with healthcare professionals using content analysis.

Main Results:

• Antibiotic Prescription Rate (APR) was 63.8% in primary and 60.8% in secondary tier hospitals.
• Multiple Antibiotic Prescription Rate (MPR) was higher in secondary tier hospitals (23.8%).
• Facilitators for AMSP implementation include infection control committees, designated nursing staff, prescription audits, and enhanced monitoring.

Conclusions:

• Lower-tier hospitals require customized antimicrobial stewardship programs (AMSP) to address high antibiotic prescribing rates.
• Current infection control activities are not integrated with AMR containment efforts.
• Optimizing antibiotic use in these facilities is vital, as they serve two-thirds of India's population.