Baseline Assessment of Antimicrobial Use and Stewardship Gaps in a Tertiary Care Hospital in South India: A Point...

Antimicrobial resistance is a major global public health concern, with a disproportionate burden in low- and middle-income countries. In hospital settings, inappropriate antimicrobial use, particularly excessive empirical and broad-spectrum prescribing, remains a key driver of resistance. Reliable baseline data on prescribing practices are essential for guiding antimicrobial stewardship interventions. Point prevalence surveys offer a standardized, resource-efficient method for assessing antimicrobial use. Yet, data from tertiary care hospitals in South India, particularly across both adult and pediatric services, remain limited.

To assess the point prevalence of antimicrobial prescribing and identify key stewardship gaps across adult and pediatric inpatient services in a tertiary care teaching hospital in South India.

A cross-sectional observational point prevalence survey was conducted in selected medicine and pediatric wards and intensive care units (ICUs). All eligible inpatients present on the survey days were included, excluding day-care admissions. The data were collected using a predesigned questionnaire adapted from the National Centre for Disease Control framework and were analyzed descriptively.

A total of 348 patients were surveyed, including 300 adults and 48 pediatric patients. Antimicrobial use varied substantially between wards and ICUs. In adult medicine wards, 29.5% of patients received antimicrobials, increasing to 75% in the medical ICU. Ceftriaxone was the most frequently prescribed agent in wards, while piperacillin-tazobactam predominated in the ICU. Pediatric antimicrobial use was 38.1% in wards and 83.3% in the pediatric ICU, with ampicillin being the most commonly prescribed agent. Empirical therapy predominated across all clinical settings. Culture-guided treatment was documented in only 6 of 115 patients (5.2%) receiving antimicrobials.

This point prevalence survey-based audit provides baseline data on antimicrobial prescribing and identifies important stewardship gaps, including high empirical use and limited culture-guided therapy. Point prevalence survey methodology represents a feasible approach for informing antimicrobial stewardship strategies in resource-constrained tertiary care settings.