Experience of an antimicrobial stewardship programme in a tertiary care hospital in Sri Lanka

Hospital-based antibiotic stewardship programmes are helpful to optimise the treatment of infectious diseases and to prevent the development of antibiotic resistance. The rise in multi-drug resistance in Sri Lankan hospitals including carbapenem-resistant organisms emphasises the need for implementation of effective AMS programmes and planned in national strategic plan to combat antimicrobial resistance. A sustainable approach towards an effective AMS pro-gramme is continuously needed. The data on experience in implementing AMS programmes in Sri Lanka is scares.

To share the experiences and challenges faced while implementing an AMS programme in a hospital. Guidelines on empirical and prophylactic use of anti-microbials and common infections were distributed to each unit. A list of antimicrobials prepared according to WHO AwaRe classification and drug chart designed for documentation of optimal prescribing.

There was a 27.3% reduction in mean carba-penem consumption after initial implementation and the consumption is gradually rising. 36% decrease in carbapenem resistance rate in Acinetobacter species, 33% reduction in carbapenem-resistant Pseudomonas species was observed. The point prevalence of anti-microbial use was found to be 45.5% and 49% in 2023 and 2024 respectively. The commonest indication for antimicrobial use in prescriptions was community-acquired infections. There was a reduction in continuing antibiotics for surgical prophylaxis after implementation of AMS programme.

For successful implementation of an AMS programme in community acquired drug resistance also should be addressed. In hospital setting continuation of surgical prophylaxis is an area which can be improved easily. Adequate staff and time allocated for AMS activities will be beneficial for sustainable programmes.