The Effectiveness of a Hospital-Based Antimicrobial Stewardship Program: A Three-Year Observational Study.

Area of Science:

• Healthcare Management
• Infectious Disease Epidemiology
• Clinical Pharmacy

Background:

• Antimicrobial resistance is a global health crisis, necessitating effective Antimicrobial Stewardship Programs (AMSP).
• Evaluating AMSP impact in diverse healthcare settings, like tertiary care hospitals in India, is crucial for optimizing antibiotic use.

Purpose of the Study:

• To assess the 3-year impact of a policy-driven AMSP on antibiotic consumption, prescribing practices, infection control, resistance patterns, and clinical outcomes.
• To compare pre-AMSP (nurse-led) and post-AMSP (multidisciplinary) phases in a tertiary care hospital in India.

Main Methods:

• A retrospective cross-sectional study design was employed.
• Data collected included antibiotic consumption (DDD, DOT), policy compliance, resistance rates (VRE, CRE), and clinical outcomes (SMR, mortality, readmissions, ICU transfers).
• Statistical significance was determined using p < 0.05.

Main Results:

• Overall antibiotic consumption (DDD/1,000 patient-days and DOT) decreased, though not significantly (p > 0.05).
• Policy compliance showed marginal improvement (78%-80%) but fluctuated; surgical prophylaxis selection improved (88%-94%, p=0.044), while duration adherence remained poor.
• Resistance rates for VRE and CRE decreased (44%-26% and 47%-42%), and Standardized Mortality Ratio (SMR) significantly declined (1.28-0.62, p < 0.001). However, all-cause mortality slightly increased, and readmissions and ICU transfers rose post-AMSP.

Conclusions:

• AMSP implementation led to process improvements and positive trends in resistance and SMR, but most changes lacked statistical significance.
• Inconsistent compliance and increased readmissions/ICU transfers underscore the need for sustained interventions and patient-level risk adjustment for AMSP effectiveness.