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Systematic review of clinical outcomes from the implementation of hospital-based antimicrobial stewardship programs
M Bhattacharjee1, K Manimekalai2, S Bhowmick3
1Sri Balaji Vidyapeeth, SBV Campus, Pillaiyarkuppam, Pondicherry, India.
Abstract:
Antimicrobial resistance (AMR) is a growing concern that can compromise clinical outcomes as well as increase the significant economic stress on healthcare systems. Antimicrobial stewardship programs (ASPs) have demonstrated promising results in improving treatment outcomes and reducing costs worldwide. However, the effectiveness of ASP in Indian hospital settings remains underexplored. This systematic review aimed to evaluate the effectiveness of implementing ASP in Indian hospital settings. Literature search was carried out in electronic databases such as PubMed, Clinical Trials Registry-India, Clinicaltrials.gov, and Google Scholar from January 2015 till April 2025 to identify published studies that explored the clinical outcomes in Indian hospital-based settings that implemented ASP. Studies that assessed at least one of the following outcomes-AMR pattern, infection rate, mortality rate, prescription pattern, costs, or barriers/challenges in ASP implementation-were eligible for screening. Two independent reviewers screened the articles for eligibility, with discrepancies resolved through discussion with a third reviewer. Out of the 1732 studies screened, 11 studies were found eligible for inclusion. Those studies were conducted in different Indian states. Each study implemented different ASP practices, including infection control, audit and feedback, and customized training. Most of the studies evaluated demonstrated improvements such as a reduction in inappropriate prescriptions, lower antimicrobial resistance rates, decreased infection and mortality rates, and reduced costs following the implementation of ASP. Despite the benefits, implementation challenges remain. This review highlights the need for strict ASP implementation and monitoring in Indian hospitals to combat AMR.
Insights
Antimicrobial stewardship programs (ASPs) in Indian hospitals reduce inappropriate prescriptions, antimicrobial resistance, and costs. Effective implementation and monitoring are crucial for combating antimicrobial resistance (AMR) in India.
Area of Science:
- Public Health
- Infectious Diseases
- Health Services Research
Background:
- Antimicrobial resistance (AMR) poses a significant global threat to healthcare systems and clinical outcomes.
- Antimicrobial stewardship programs (ASPs) are recognized strategies for improving antimicrobial use and reducing healthcare costs.
- The impact and effectiveness of ASPs in Indian hospital settings are not well-documented.
Purpose of the Study:
- To systematically review the effectiveness of implementing antimicrobial stewardship programs (ASPs) in Indian hospital settings.
- To evaluate the impact of ASPs on antimicrobial resistance patterns, clinical outcomes, and healthcare costs in India.
Main Methods:
- A systematic literature search was conducted in PubMed, Clinical Trials Registry-India, Clinicaltrials.gov, and Google Scholar (January 2015 - April 2025).
- Studies assessing AMR patterns, infection rates, mortality, prescription patterns, costs, or ASP implementation challenges were included.
- Eleven studies met the eligibility criteria after screening 1732 articles, with data extracted and analyzed.
Main Results:
- Implementation of various ASP practices (infection control, audit, training) in Indian hospitals led to significant improvements.
- Observed benefits include reduced inappropriate prescriptions, lower antimicrobial resistance rates, decreased infection and mortality rates, and cost savings.
- Despite positive outcomes, challenges in ASP implementation persist across different Indian hospital settings.
Conclusions:
- Antimicrobial stewardship programs are effective in improving clinical outcomes and reducing costs in Indian hospitals.
- Addressing implementation challenges is essential for maximizing the benefits of ASPs.
- Strict implementation and continuous monitoring of ASPs are vital for combating antimicrobial resistance in India.
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