Gaps and Opportunities in Antimicrobial Stewardship and Surgical Site Infection Surveillance Across India

Background: Surgical site infections (SSIs) constitute major yet preventable complications. Antimicrobial stewardship programs (ASPs) are evidence-based interventions recommended to reduce SSI incidence, yet their implementation and impact in India remain poorly characterized. This study aimed to assess current ASP implementation and SSI surveillance practices in Indian hospitals to identify gaps and inform future interventions. Methods: A prospective cross-sectional survey of five geographically diverse Indian academic medical centers was conducted between 2017 and 2021, assessing existing ASPs, surgical volume, SSI incidence and surveillance protocols, prevalence of multi-drug-resistant organisms (MDRO), and microbiology laboratory capability. Data were collected using REDCap® and analyzed for inter-center variations. Results: Three of five (60%) centers completed the survey. All reported SSI surveillance, with heterogenous monitoring frequency (i.e., daily to monthly). Two had formal patient safety and infection prevention committees; none had an ASP committee. Only one provided formalized education on pre-operative patient preparation or ASP principles. All had an accessible microbiology laboratory, but only one had pharmacy informatics to track antimicrobial agent utilization. Across hospitals, the mean (range) MDRO prevalence was as follows: methicillin-resistant Staphylococcus aureus 3.9% (1.5%-11.5%); extended-spectrum beta-lactamase producers 32.7% (15.1%-57.4%); and carbapenem-resistance 16.0% (3.7%-30.0%). Conclusions: ASP implementation and SSI surveillance practices vary widely across Indian academic hospitals, with key gaps in committee oversight, clinician education, informatics infrastructure, and subspeciality-based data. High MDRO rates highlight the urgent need for standardized, scalable stewardship frameworks tailored to the Indian healthcare context. Multiple opportunities exist to address these gaps and combat antimicrobial agent resistance at a national level, but a lack of infrastructure poses barriers.